This document is an application form for membership in the Fire & Safety Association of India (FSAI). It requests the applicant's contact information, including name, address, phone number and email. It also requests payment of admission and annual membership fees, and signatures to agree to be governed by FSAI's constitution and bylaws. For institutional memberships, it requests additional details like director names, business activities and designated representatives.

1. Phone No: Application No.
FIRE & SAFETY ASSOCIATION OF
INDIA
APPLICATION FOR MEMBERSHIP
The Secretary
FSAI
No.19/1, Kannadasan Salai,
T.Nagar, Chennai 600017
I/We hereby make application for membership in the FIRE & SAFETY ASSOCIATION OF INDIA and agree to
be governed by its Constitution, By-Laws and Rules.
Member Name (Institutional/Individual)
_____________________________________________________________
I/We send herewith DD/cheque of Rs. ______(Rupees
________________________________________________)
In favour of “FIRE & SAFETY ASSOCIATION OF INDIA“ comprising of the following fees:
Institutional (Voting) Individual
Admission Fee: Rs. 15,000/- Rs. 1,500/-
Annual Membership Fee: Rs. 7,500/- Rs. 1,000/-
CHECK PREFERRED MAILING ADDRESS: BUSINESS C OR HOME
Business:
Your Current Title(s) :
_________________________________________________________________________
Company Name : _________________________________________________________________________
Business Address / :
_________________________________________________________________________
Street : _________________________________________________________________________
Telephone : _____________________________________ Fax No. ____________________________
Email Address : _____________________________________ Website ____________________________
Home:

2. Home Address / Street : ______________________________________________________________________
_______________________________________________________________________
Telephone : ___________________________________ Fax No. ____________________________
Email Address : ___________________________________ Website ____________________________
Signature of Applicant : ___________________________________ Date
_______________________________
For Institutional Membership:
Name/Names of the Directors :
_________________________________________________________________
Constitution of Firm : ______________________________________Yr. of Est. ___________________
Core Business Activities : _________________________________________________________________
Designated Representatives
(Name#1 will be the main Contact and will receive all FSAI correspondence)
Name 1 : ________________________________________ Signature _____________________________
Address : _________________________________________________________________(in block letters)
Designation : ______________________________________________________________________________
Name 2 : _________________________________________ Signature ____________________________
Address : _________________________________________________________________(in block letters)
Designation : ______________________________________________________________________________
Please indicate if you are a member of other
Association________________________________________________
FOR OFFICE USE ONLY
Date of Receipt
_____________________________________________________________________________
Bank Draft/Cheque No. _____________________ for Rs. ____________________ drawn on
_______________
Membership No.
Approved By: President General Secretary Treasurer