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INDIAN MEDICAL ASSOCIATION IMA AP STATE APPLICATION FOR TRANSFER OF MEMBERSHIP TO A DIFFERENT BRANCH WITHIN ANDHRA PRADESH XEROX MAY BE USED COUPLE MEMBERS TO APPLY SEPERATLY To The Honorary State Secretary IMA AP State IMA Building Isamia Bazar Hyderabad-500 027 Ph 040-24656378 Fax 040-24738197 Through 1. Branch Secretary------------------------------------------------- Sending Branch Dear Sir I request you to transfer my membership from ------------------------------------------Branch Sending Branch to --------------------------------------Branch receiving Branch as ------------------------------------------------------------------------ reasons. Name of the Applicant for Transfer Dr. -----------------------------------------------------------------------Life Membership No ----------------------------------------------------------------------------------------------Address ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Tel ------------------------------------------- Mobile---------------------------------------------------------------If Member of FBS No ---------------------------------------------------------------------------------------------If Member of PP W Scheme ------------------------------------------------------------------------------------If Member of APPA FSS No ------------------------------------------------------------------------------------Thanking you Member Signature P. T. O No Objection from Sending Branch The ---------------------------------------------- Branch Sending Branch has no objection to the above transfer. The member has no dues to their branch. We are enclosing the branch share of Life membership contribution by D. D. No*---------------------------- in favour of Hony. Secretary----------------------------------------------- Branch receiving Yours Sincerely Hony. Secretary Sending Branch Acceptance by the Receiving Branch membership and received the local branch contribution* Forwarded to Hony. State Secretary with a request to intimate the transfer to Head Quarters. Copies of the application to be retained by each local branch. Branch Secretary------------------------------------------------- Sending Branch Dear Sir I request you to transfer my membership from ------------------------------------------Branch Sending Branch to --------------------------------------Branch receiving Branch as ------------------------------------------------------------------------ reasons. Name of the Applicant for Transfer Dr. -----------------------------------------------------------------------Life Membership No ----------------------------------------------------------------------------------------------Address ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Tel ------------------------------------------- Mobile---------------------------------------------------------------If Member of FBS No ---------------------------------------------------------------------------------------------If Member of PP W Scheme ------------------------------------------------------------------------------------If Member of APPA FSS No ------------------------------------------------------------------------------------Thanking you Member Signature P.

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