NEWS LETTER - INDIAN ASSOCIATION OF PHYSIOTHERAPISTS - MAY, 2019
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SECONDED BY:
NAME:_______________________________________________________________________
(FIRST NAME) (MIDDLE NAME) (SURNAME)
LIFE MEMBERSHIP NO: __________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: _____________STATE:___________________________PIN CODE:__________________
EMAIL:___________________________________________MOBILE NO:_________________
POST: ________________________________________________
SIGNATURE OF CANDIDATE DATE:
LIST OF ENCLOSURES:
1]
Nomination Form for Each Post.
2]
Copy of membership certificate of contestant.
3]
Copy of membership certificate of Proposer.
4]
Copy of membership certificate of Seconder.
5]
Copy of Voter I.D Card. of Contestant
6]
Copy of Aadhar Card. of Contestant.
7]
Election Fee of Rs. 15,000 by Demand Draft In favour of Indian Association of
Physiotherapists , Payable at Indore.
8]
Electoral Roll Charges if require by Candidate by D.D of Rs 5,000/Roll In Favour of Indian
Association of Physiotherapists, Payable at Indore.
9]
Notarised Affidavit by the Candidate in Given Format.
10] Notarised Model Code of Conduct in Given Format.
DECLARATION BY THE CANDIDATE
I, Dr____________________________________________ sign my willingness to serve as
Member of the executive committee of Central/ State. I further declare that if I am elected to the
said post, I would attend at least two meetings of the executive committee and all General body
meeting every year. I hereby certify that the above information provided is correct. If the same is
found incorrect, my nomination is liable to be cancelled.
SIGNATUREOFTHECANDIDATE:
PLACE:
DATE:
