To

The Accounts Officer,

__________________

___________________

Sir, Madam,

I,__________________________________, (Name and Designation), a member of BSNL Employees Union hereby authorize you to deduct Rs. 10/- from my salary as my subscription to the Union payable to the BSNL Employees Union units as follows :

Circle Branch (Circle Secretary) - Rs. 7/-

Central HQs. (General Secretary) - Rs. 3/-

Yours faithfully,

(SIGNATURE)

Name___________________

Designation___________________

Staff No._______________________

Place of Posting___________________

Station _______________

Dated_________________

It is certified that Shri/Smt./Ms. _____________________________ is a Member of the BSNL Employees Union.

SIGNATURE OF BRANCH/DISTRICT SECRETARY

(STAMP OF THE UNION)

SIGNATURE OF CONTROLLING OFFICER

(GROUP B LEVEL AND ABOVE)

NAME AND DESIGNATION WITH

OFFICE SEAL.

Name of official :____________________________________________________

Designation :________________________________________________________

Office :_____________________________________________________________

Age :________________________________________________________________

Date of entry in service :_________________________________________________

I certify that the particulars given above are correct. I agree to abide by the Constitution of the Union. I request that I be enrolled as a member of BSNL Employees Union.

Place :

Date :

Com.__________________________ of ____________________________________ is

enrolled as member of BSNL Employees Union, ________________ Branch.