The Western India Automobile Association
76, Veer Nariman Road, Churchgate, Mumbai 400 020

MEMBERSHIP FORM
(FOR INDIVIDUALS)

Name in Full Mr./ Mrs./ Ms.-__________________________________________________________
(In block letters. Underline Surname)

Office Address _____________________________________________________________________

__________________________________________________________________________________

Residential Address__________________________________________________________________
(mark by X the address for correspondence)
___________________________________________________________________________________

Telephone Nos. Office__________________________ Residence ____________________________

Driving Licence Number_________________________ Date of Expiry _________________________

Details of Vehicles to be registered for Service

Registration Number of Vehicle	Make	Year of Manufacture
1.
2.
3.
4.

I agree to be bound by all rules of the Association and the alterations made therein from time to time.

Paid by cash / cheque No._______________dated _____________ an amount of Rs._____________

Note: 1. Applicants can register for service, only vehicles owned by them and their spouses. They can
also include one vehicle given to them for use by the company

Note: 2. Applicants must produce Registration/Taxation Certificate of the vehicles to be registered for service.

Proposed by ______________________________________________ Membership No.____________

Seconded by ______________________________________________ Membership No.____________


Click here for Corporate / Institutions Membership Form