Nomination Form for Post of President IMA Hoshiarpur for Year 2017
Name (in block letters)…………………………………………………………………
Address…………………………………………………………………………………
…………………………………………………………………………………………
Phone:-Landline………………………….. Cell No…………………………………
Email…………………………………………………………………………………
Life membership Number…………………………………………………………….
Date of joining IMA Hoshiarpur……………………………………………………
Proposed By Seconded By
Dr……………………………….. Dr……………………………
Life membership No…………………….. Life Membership No…………………..
Signature Signature.
Consent by the Candidate.
I, Dr…………………………Life membership no………………………………………..…. give my consent to fight the elections for the post of President IMA Hoshiarpur
Signatures
Name …………………………
Documents to be attached:-
- Bank Draft of Rs 2000/- in favour of IMA Hoshiarpur payable at Hoshiarpur
- Undertaking by the candidate ( Rule 24.a.vi )
- Self attested Photocopy of the IMA Membership certificate
Note:- The nomination form complete in all respects along with the undertaking by the candidate mentioned vide Rule 24(a.vi) (format given below) should be sent so as to reach the office of the CEC IMA Hoshiarpur on or before 5.00 PM on the last day of the filing of the nominations as mentioned in the Election notification.