FORM NO 4
[Under the Bye-law No. 19(A) (v)]
A Form of undertaking to be furnished by the person, on whom the prospective Non-Earning Member is dependent for discharge of liabilities to the society.
To,
The Chief Promoter/Secretary
………………………………Co-operative Housing Society Ltd.
……………………………………………………………………………………
Sir,
I, Shri /Shrimati ………………………………………… has made an application for membership of the …………………………… Co-operative Housing Society Ltd having address at …………………….…., Mumbai ………….………. He/ She has no independent source of income a dependent on me. I therefore, undertake to discharge all the liabilities, present and future, payable by her/his on her/ admission to membership of the society on her/his behalf as communicated to me directly or through her/him from time to time, by the Society. On failure of such discharge in respect of dues, I shall also be liable for recovery u/s 101 of the MSC Act 1960, along with the said member who is dependent on me.
My details are given below: –
1. Name: Shri/ Smt. ………………………………………………………………………………………………………………..
2. My Address: …………………………………………………………………………………………………………………………
a. Office: ……………………………………………………………………………………………………………………..
b. Residence: ……………………………………………………………………………………………………………….
c. Contact Details: ……………………………………………………………………………………………………….
3. Occupation: ………………………………………………………………………………………………………………………….
4. Name & Full Address of the employer: ………………………………………………………………………………….
5. Monthly Income: …………………………………………………………………………………………………………………..
Place:
Date:
Yours faithfully,
Signature …………………………..