Provisional Affiliation Application
nd
Mail to: JCI INDIA, National Headquarter, 2 floor, Ami-kalash, Ami Complex, IC Colony Road, Borivali(W) Mumbai-400 103, Ph:
022-28913355, 28912354. Fax: 28910807. E-mail: [email protected]
Name of the proposed Chapter
Zone
Region
Area
Name of the Sponsorer
Zone
Region
Area
Orientation details
Date of adoch
committee formed
Date of Title Clearance Approval
Name and Designation of Orientation Officer
Date
Place/Venue
Number of Members
Present
Payment details (Affiliation fee Rs.1000/-, Membership fees Rs.618/- per member per half)
Number of Members
Demand Draft No.
Date
Amount
Mailing Address of
Founder President
City
Phone (Bus) with STD code
Pin
Phone (Res)
E-Mail :*
Mobile
Web Site :
Mailing Address of
Founder Secretary
City
Phone (Bus) with STD code
State
Mobile*
E-Mail :*
Drawn on Bank
Pin
Phone (Res)
State
Mobile*
Web Site :
Mobile
Provisional Affiliation Application
Resolution of Adoch Committee
WHEREAS, the undersigned body of young persons having met in the city/town of
have been thoroughly oriented about the ideals and purposes of the Jaycees movement.
WHEREAS, the body has now decided to formally organize itself as a society and function as a Chapter of JCI India. BE IT FURTHER
RESOLVED, that this body be called
and hereby apply for affiliation to JCI
INDIA.
BE IT FURTHER RESOLVED that Mr/Ms
Mr/Ms.
President of ADHOC COMMITTEE AND and
Secretary of ADHOC COMMITTEE be authorised to file all applications,
papers and subscriptions with the Zone President on behalf of the attached founder members.
Signature of the President
Signature of the Secretary
Proposal of Sponsorship by JCI India Chapter
I, the President of JCI
_______________________convinced of the need of promotion of a chapter at
___________in JCI India Zone _______and certify that the founder members of this proposed
Chapter have been oriented about Jaycees by the officer appointed by the Zone President and confirm that
we will look after the Chapter up to their Permanent Affiliation with JCI India.
NGB Member
Name of the NGB Member
Zone
Please specify the name of the LOM whom the credit of the extension to be given.
Signature of the NGB Member
Provisional Affiliation Application
Form of Adherence
The Secretary
General, JCI India,
Sir,
We, the members of JCI
(Name of the New LOM) have carefully read and fully understood
the provisions of the Memorandum of Association and the Articles and the Policy Manual of JCI India and do hereby declare and agree
that we will during our membership of the said JCI India, in all things submit to all the provisions of the said Memorandum of
Association and the Rules and Regulations and such other rules as the association shall make by resolutions duly passed in
accordance with the relevant provisions contained therein and also state that we shall endeavour to further the objectives of JCI India.
We hereby further declare and state that we have adopted the Model LOM Constitution of JCI India as our chapter's constitution, subject
to whatever changes that may be introduced from time to time in the Model LOM constitution of JCI India as we also hereby undertake
that we will not make any changes in the said constitution which may be derogatory to the provision of the Constitution and Policy
Manual of JCI India. If we adopt any changes in the Model LOM Constitution, then we hereby guarantee that the said copy of Model
LOM Constitution will be forwarded to National Headquarters.
Place:
Date
Signature of the LOM President
For the use of National Head Quarter
Application received at NHQ on
Provisional Affiliation granted on
Date of Provisional Affiliation materials dispatched on
Important Notes
o
o
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Provisional Affiliation application should be filled by the applicant
Affiliation application form must be forwarded through the Zone President only List of all founder members along with their
signature must be attached. Certificates of orientation conducted by JCI INDIA officer must be attached Membership fee must be
sent @ Rs. 618/- per member for minimum 20 members Incomplete application form will not be considered
Affiliation fee Rs. 1000/- must be sent (less the Title Clearance remittance)
Provisional affiliation will be granted to the new LOM w.e.f the date on which the application complete
at the NHQ. Affiliation will be dispatched to the new LOM directly from the National Head Quarters
At the time of granting Affiliation the new membership kits will be given free of cost
The new LOM will get a colar and gaval from the NHQ.