Membership Form



Name :
Photo : (Passport size Photo)
Date Of Birth : Pick a date
Number of Roll in
Orissa State Bar Council(With Date):
Pick a date
Bar Council Welfare Fund No: Pick a date
Are You a Member of Pension Fund
of Bar Council:
Yes No If Yes , SL NO:
Name of Your Father: Occuaption:
Name of Your Mother: Occuaption:
Name of Your Wife/Husband: Occuaption:
Blood Group:
Your Permanent Address:
Your Present Address:
Your Telephone Number:

Pre Enrollment Activities:
College Career Activities:
Whether You are Member of any
Other Bar Association ?(Name it):
Social Activities (If Any):
Your Extra Curricular Activities
(If Any):
Any Other Useful Information
you would like to note here :
Present Place of Practice:
Present Law Office Name:
Recommendation by Two Members of This Bar Association:
1.Name of The Identifying Member:
Enrollment Number:

Full Signature
2.Name of The Identifying Member: Enrollment Number:

Full Signature
Education/Professional/Any Other Qualification:
Examination Passed Institution / College Year of Passing Board / University %age of Marks
Matriculation:
Graduation:
Law Degree:
Post Graduation:
Name(s) of Your son(s) & daughter(s):
       I undertake to abide by the rules of discipline of the Bar Association and adjust myself to the available facilities of the Bar . Further , I undertake that , I will clear my Membership Fee , Locker Fees & Cause List dues regularly.
Date: Full Signature of Applicant:


Enclosures:

(a)HSC Certificate
(b)Enrollment Certificate
(c)Two Passport size Photo (In court gown dress)
(d)Receipt of this form

New Members Fee Rs : 5200/-