MUI FORM

Membership fees : Rs. 1800/- per annum
Entrance Fees (For first time members - one time payment) : Rs. 500/-

Please Affix Your Recent Photograph:

Full Name (surname first) * :

Date of Birth * :

Place of Birth * :

INDos No * :

Marital Status:

Married Unmarried

C.D.C. No * :

Place Of Issue * :

Issued On * :

Expires On * :

Passport No * :

Place Of Issue * :

Issued On * :

Expires On * :

Name Of Your Present Company * :

Present Rank * :

Employment Code No:

Particulars Of Your Last Company:

Address1:

Address2:

Address3:

Address4:

State:

City:

Pin Code:

LandLine No.:

Mobile No * :

Spouse / Next of Kin:

Email Address * :

Sr No.	Full Name	Relationship	Mobile	E-mail ID
Details Of Next Of kin Declared By You At The Time Of Joining The Company
1
2
3
4

The details are required to assist you in case of contingency and/or in case of emergency.
I will be abide by the rules and regulation of constitution of the Union, I agree, undertake and confirm that all agreements entered and or execute by MUI towards representation of its members shall be binding and enforceable by/upon me and accordingly, I authorise MUI to directly collect my membership fees through my employer.
I therefore request you to enroll me as the member and/or renew my membership of the The Maritime Union of India.

Place :

COC protection is extende to fully paid up members only. Certificate protection fees of Rs.200 (Rupees two hundred only) per year payable on or before renew date.

membership form