-
Please affix recent passport size photograph:
-
Name of the applicant (in block letters):
-
Father’s / Husband’s Name:
-
Age and Date of Birth (attach proof):
-
Address (Residence):
Pin:
Telephone/mobileFax
E-mail
Address (Office):
Pin
TelephoneFax
E-mail
-
Date of Enrolment as an Advocate and its Number with the Bar Council (attach copy of Enrolment Certificate) :
-
Date since practising as Advocate:
-
Usual place(s) of practice (also give name(s) of the Court/Tribunal/Other Authority):
-
Name of the Association of Advocates of which the applicant is a member through which the applicant claims benefit under the Act:
-
Whether practice discontinued for any period and reasons therefor:
-
Whether the applicant is in part/full-time service; if yes, give particulars:
-
Name and address of the nominee (s); the amount or share payable to each of the nominees(s):
-
Name, age, occupation and other particulars of dependent (s): (Note: Attach separate sheet, if necessary)
