1) the undersigned, hereby apply for the Membership of IMA Maharashtra State Social Security Scheme,

2) I do hereby declare that the above answers are true and that I have withheld no information whatsoever regarding the
application.

3) Since there is no medical examination while joining the scheme, no benefits will be given to me for one year from the date
of registration as a member.

4) I agree to pay yearly amount demanded as per deaths of members of this scheme +Annual subscription

5) I will Inquire with office, If I do not receive the demand notice of FFC Latest by 10 th May every year.

6) I further agree to abide by the conditions laid down in the constitution & amendments approved by the Annual General
Body of IMA – MS-SSS.

7) Dispute of any nature whatsoever will be subjected to Mumbai Jurisdiction Only.

8) I am a life member of INDIAN MEDICAL ASSOCIATION ……PUNE… BRANCH OF MAHARASHTRA STATE

9) I shall inform any change of Address / Phone / Mobile / Email/Nominee immediately on my Letterhead.

10)1 shall quote IMA – MS – SSS Membership No. in every correspondence.