Coal Ash Institute Membership Form

Full Name

Date Of Birth

Contact Number

E-mail Address

Official Address

Residential Address

Qualification

University / Institute Name

Year of Passing

Name of the Organization

Position Head Name

Duration

Beneficiary Name Coal Ash Institute of India

Beneficiary Bank Name Punjab National Bank

Beneficiary Branch Name Highcourt (Kolkata) WB-700001

Beneficiary Account Number 009105000

IFSC Code PUNB0009120

Account Type Current Account

Beneficiary Mobile Number 000000000000

Beneficiary Email ID Coal @gmail.com

APPLICATION FORM FOR INDIVIDUAL MEMBERSHIP