No. XII/71, Thiruvathira Building, Star Nagar , P.O Perinchery,

Thrissur - 680306, Kerala, INDIA

INDIAN CRIMINOLOGY & FORENSIC SCIENCE ASSOCIATION

MEMBERSHIP FORM

*Membership Type-

Name :

Date of Birth :

DAY MONTH YEAR

Sex : Male

Female

PIN Code :

PIN Code :

PIN Code :

Contact Address :

Office/ College Address :

Address for

Correspondences :

Name

Signature

Email ID

Tele No.

Mobile No.

* Kindly read the Rules & Regulations of ICFSA (pg.4,5,6 & 7) before filling this form

1

Annual member

Student member

Life member

Honorary member

Left Thumb Impression

Photo

( Self Attested)

Reg. No. TSR/TC/913/2012

Blood Group :

:

:

:

* Name and signature in all the pages is compulsory

Educational and Professional Qualifications: (Attach separate sheet, if required)

Fellowship (If any):

Research Publications (If any):

  Private Investigator/ Detective

  Teacher/Professor

  Government Examiner/Scientist/Criminologist

  Forensic Expert / Scientist / Investigator

  Lawyer / Advocate/Psychologist

  Student

  Other (specify)..............................

Your Designation / Post ………………………………………………………………….

Your Expert Area………………………………………………………………….............

2

Work Experience: (Attach separate sheet, if required)

Employment Status and Details :

Name

Signature

EXPERIENCE ORGANIZATION/ AGENCY YEARS

QUALIFICATION UNIVERSITY AND YEAR GRADE MAIN SUBJECTS

Declaration

I am submitting this application form to become a …………………… Member of INDIAN CRIMINOLOGY

& FORENSIC SCIENCE ASSOCIATION (ICFSA) and hereby declare that all the above information is true and

correct. I have carefully read all the rules and regulations of ICFSA, I fully accept and agree to abide by the same.

I voluntarily agree to pay the membership fees that are mutually agreed upon us.

Please find enclosed herewith

1. Cheque / Demand Draft of Rs.____________ in favor of “INDIAN CRIMINOLOGY & FORENSIC

SCIENCE ASSOCIATION” payable at THRISSUR, KERALA.(Members may also pay by Cash, Cash

Deposit, Credit Card or Online Transfer to Account No: 32695002689, SBI,

Thrissur, Kerala, IFSC Code: - SBIN0000940) NB:Mention

the details of cash deposit / online transfer.........................................................

2. Self attested Copy of Academic Qualification Certificates : Yes / No

3. Self attested Copy of Professional Qualification Certificates : Yes /No

4. Self attested Copy of Experience Certificates : Yes / No

5. Attach your C V : Yes/ No

6. Attach one recent Passport size colour photo : Yes / No

7. Other Documents ( If Any).............................................

INDIAN CRIMINOLOGY

& FORENSIC SCIENCE ASSOCIATION

Place…………………………….

Date……………………………..Name & Signature

Send this Completed Form in paper via post, or courier with Self attested Copies of all Required documents to

INDIAN CRIMINOLOGY & FORENSIC SCIENCE ASSOCIATION

No. XII/71, Thiruvathira Building, Star Nagar , P.O Perinchery

Thrissur - 680306, Kerala, INDIA

…………………………………………………………………………………..............

…………………………………………………………………………………..............

FOR OFFICE USE ONLY

Criteria Date Authority Signature Comments / Details/

Remark

Application Received

Payment Received

Approved as Member

I-Card

Registration/Ref No

President Secretary Treasurer

Approved as Member by the Executive Committee held on………..

3

4Name

Signature

5

Name

Signature

6Name

Signature

7

Name

Signature