Shushrusha Citizens Co-Operative Hospital Ltd.

Registration Under Maharashtra Co-operative Society Act. 1960

REGD NO. BOM-GNL-114 OF 1964.

698-B, Ranade Road, Dadar (W), Mumbai – 400028. India.


Shushrusha Citizens’ Co-operative Hospoital Ltd.

698-B, Ranade Road, Dadar, Mumbai – 400 028.

Application Form for Membership and Shares

Sir / Madam,

I Shri / Smt / Mrs / Miss _____________________________________________ the undersigned hereby request you to admit me as a member of your society. Please allot me 100 shares.

I am sending herewith a sum of Rs. 10200/-(Ten Thousand Two Hundred Only) being Rs. 10000/- as a value of 100 shares, Rs.100/- as the cost of Family ID - card and Rs. 100/- as entrance fee.

I here gone through the Bye lows of your society and undertake to abide by them as they stand or as they might stand with modifications which may be made from time to time.

Particulars to be filled in by applicant in Block Letters.

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Nomination (To be filled in by the applicant)

As per the requirement of the Maharashtra Co-operative Societies Act. 1960 section 30 (1) and The Maharashtra Co-operative Societies rules. 1961 - Rule No 24.