Section 140(9) in Goa Co-operative Societies Rules, 2003

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(9)Name, Phone number and Postal Address of the person to whom correspondence regarding registration or otherwise should be addressed:-

Sr. No.	Full name of promoters	Whether individual or Corporate body	Age	Nationality	Profession	Place of residence/ office (in case of corporatebody) Village & Taluka	Amount subscribed to share capital	Whether any other signatory of the application isa member of his family	In the case of representative of society, whetherhe is member of the committee of the society.	Signature
1	2	3	4	5	6	7	8	9	10	11
1.2.3.4.5.6.7.8.9.10.	Chief Promoter

We declare that the information given above including that in the enclosures are correct to the best of our knowledge.Enclosures:-

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