Corporate Membership Form

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    Annual MemberLife Member

      A.Personal Profile

    1. Name of Company Organization/ Firm

    2. Address

    3. Pin

    4. Tel Off

    5. Fax

    6. Website

    7. Email

    8. (a) Nature of Organization

    9. (b) Nature of Employee

    10. Name, Designation and Address of Nominees(Maximum Four)

    11. 1st Nominee

    12. Name

    13. Designation

    14. Address

    15. Pin

    16. Tel Off

    17. Fax

    18. Tel Res

    19. Email

    20. Mobile

    21. 2nd Nominee

    22. Name

    23. Designation

    24. Address

    25. Pin

    26. Tel Off

    27. Fax

    28. Tel Res

    29. Email

    30. Mobile

    31. Whether the applicant or its nominees are the member of any other Anti Corruption Academy/ Committee, mention the name of such academy/ committee, address & the year of its establishment

    32. Whether the applicant's application for membership of this Academy was rejected or withdrawn at any time:If Yes, give details

    33. Whether the applicant's applicantion for membership was rejected or withdrawn at any other Academy/ Committee:If Yes, give details

    34. Have the applicant or its nominees been charge sheeted for corruption or any criminal act:If Yes, give details

    35. Have the applicant or its nominees ever been convicted by a court of any offence, whether involving moral turpitude or otherwise, and sentenced in respect thereof to imprisonment: If Yes, give details

    36. We agree to abide by the Memorandum of Association and Rules & Regulations of the Academy as in force from time to time and enclose a cheque/bank Draft No

    37. Dated

    38. Drawn On

    39. For Rs.

    40. (Entrance Fee Rs.

    41. + Annual Subscription fees

    42. + Life Membership fees Rs.)

    43. We further certify that the above inforamtion is true to the best of my knowledge and belief. The Membership is liable to be cancelled if the information furnished is found to be incorrect.

    44. Name

    45. Desgination

    46. Date

      47. >

    47. Membership No

    48. Membership No

    Category of Member

    Admission fee

    Annual fee

    Lifetime

    Body Corporate/Institutions

    INR 10,000

    INR 1,00,000

    INR 5,00,000

    Undertaking

    1. We hereby affirm our allegiance to the constitution of India and undertake to uphold its provision in our personal, official and public life.

    2. We hereby certify that all the information furnished with this application are true.

    3. We undertake that we will not make use of ACA(Anti-Corruption Academy) for any personal gain nor put its logo and name on our personal letterhead or any other document. In case of violation of the undertaking or any breach of conduct, ACA India will be free to terminate our Membership.

    4. We hereby confirm that I am not involved in any Corruption? Criminal cases.

    5. We Accept

    6. Authorised Signatory

      C-660, New Friends Colony, New Delhi - 110025. Tel: +91-11-4978-5524

      B-101, Greenville, Near Lokhandwala Club, Lokhandwala Complex, Andheri-West, Mumbai - 400053. Tel: +91-22-4016-7394

      admin@acaindia.net   www.acaindia.net




      Annual MemberLife Member

        A.Personal Profile

      1. Name of Company Organization/ Firm

      2. Address

      3. Pin

      4. Tel Off

      5. Fax

      6. Website

      7. Email

      8. (a) Nature of Organization

      9. (b) Nature of Employee

      10. Name, Designation and Address of Nominees(Maximum Four)

      11. 1st Nominee

      12. Name

      13. Designation

      14. Address

      15. Pin

      16. Tel Off

      17. Fax

      18. Tel Res

      19. Email

      20. Mobile

      21. 2nd Nominee

      22. Name

      23. Designation

      24. Address

      25. Pin

      26. Tel Off

      27. Fax

      28. Tel Res

      29. Email

      30. Mobile

      31. Whether the applicant or its nominees are the member of any other Anti Corruption Academy/ Committee, mention the name of such academy/ committee, address & the year of its establishment

      32. Whether the applicant's application for membership of this Academy was rejected or withdrawn at any time:If Yes, give details

      33. Whether the applicant's applicantion for membership was rejected or withdrawn at any other Academy/ Committee:If Yes, give details

      34. Have the applicant or its nominees been charge sheeted for corruption or any criminal act:If Yes, give details

      35. Have the applicant or its nominees ever been convicted by a court of any offence, whether involving moral turpitude or otherwise, and sentenced in respect thereof to imprisonment: If Yes, give details

      36. We agree to abide by the Memorandum of Association and Rules & Regulations of the Academy as in force from time to time and enclose a cheque/bank Draft No

      37. Dated

      38. Drawn On

      39. For Rs.

      40. (Entrance Fee Rs.

      41. + Annual Subscription fees

      42. + Life Membership fees Rs.)

      43. We further certify that the above inforamtion is true to the best of my knowledge and belief. The Membership is liable to be cancelled if the information furnished is found to be incorrect.

      44. Name

      45. Desgination

      46. Date

        47. >

      47. Membership No

      48. Membership No

      Category of Member

      Admission fee

      Annual fee

      Lifetime

      Body Corporate/Institutions

      INR 10,000

      INR 1,00,000

      INR 5,00,000

      Undertaking

      1. We hereby affirm our allegiance to the constitution of India and undertake to uphold its provision in our personal, official and public life.

      2. We hereby certify that all the information furnished with this application are true.

      3. We undertake that we will not make use of ACA(Anti-Corruption Academy) for any personal gain nor put its logo and name on our personal letterhead or any other document. In case of violation of the undertaking or any breach of conduct, ACA India will be free to terminate our Membership.

      4. We hereby confirm that I am not involved in any Corruption? Criminal cases.

      5. We Accept

      6. Authorised Signatory

        C-660, New Friends Colony, New Delhi - 110025. Tel: +91-11-4978-5524

        B-101, Greenville, Near Lokhandwala Club, Lokhandwala Complex, Andheri-West, Mumbai - 400053. Tel: +91-22-4016-7394

        admin@acaindia.net   www.acaindia.net

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