Forms – Punjab & Haryana High Court Bar Association

BCI SC Info E - Committee

Sr. No.

Enrolment Number of Advocate in State Bar Council with the year of enrolment

Certificate of Practice details, issued after clearance of AIBE, wherever applicable

Name of Advocate (to be printed in short on cause list)

Full name of Advocate

Name of Advocate in Local Language

Date of Birth of Advocate

Gender of Advocate (M-Male, F-Female, T-Transgender)

Address of Advocate

Address of Advocate in Local Language

Email of Advocate

Mobile number of Advocate

Whatsapp (if any)

Phone number of Advocate

Fax Number

Office Address of Advocate where he practices

Pin Code

District

Taluka

Office Address of Advocate in local language

Type of Advocate, (Individual-1, Firm-2, Company-3)

If Firm or Company, Registration No. in BCI.

Signature of Advocate

Accounts Office Report

Photo

I am remitting a sum of Rs by Cash/Cheque/Demand Draft towards membership.

Name (In Block Letters)

Son/Daughter of (In Block Letters) Sh.

Residence Address

Office Address

Contact Number

Previous Place of practice (If Any)

Were you ever member of Association before

Yes No

If yes then briefly state why and when you ceased to be a member

Are you member of any other Bar Bar Association? Yes/No If Yes,Give Particulars

Particulars of Enrollment as an Advocate with Bar Council:

Date of Birth

Enrollment Number

Date of Enrollment

Name of Bar Council

Is there any break in your practice since enrolment

Whether any member of family already in profession,If yes give brief particulars

Name of proposer

Address

Enrollment No

Signature

Name of Seconder

Address

Enrollment No

Signature

I shall exercise my right to vote at

Photo

I am remitting a sum of Rs by Cash/Cheque/Demand Draft towards membership.

Name (In Block Letters)

Son/Daughter of (In Block Letters) Sh.

Residence Address

Office Address

Contact Number

Previous Place of practice (If Any)

Were you ever member of Association before

Yes No

If yes then briefly state why and when you ceased to be a member

Are you member of any other Bar Bar Association? Yes/No If Yes,Give Particulars

Particulars of Enrollment as an Advocate with Bar Council: Date of Birth Enrollment Number Date of Enrollment Name of Bar Council

Is there any break in your practice since enrolment

Whether any member of family already in profession,If yes give brief particulars

Details of Previous Service:

Name of proposer

Address

Enrollment No

Signature

Name of Seconder

Address

Enrollment No

Signature

I shall exercise my right to vote at

Name of Advocate

Father/Husband's Name

Enrolment no. with Punjab and Haryana Bar Council

Membership no. with the Punjab and Haryana High Court Bar Association

Correspondence Address

Permanent place of practice

Subscription of the Bar Association paid upto month of 2020

Date of admission in the Hospital

Date of Discharge

Nature of ailment

The period of Hospitalisation

Name of the Hospitalisation/Dispensary/Institution Nursing Home/Clinic etc.

Give the following information:

Date of commencement of treatment.

Date of completion of treatment.

Name and address of attending medical practitioner.

Telephone No

Registration No

Schedule of expenses incurred by the claimant under Hospitalisation

Affidavit

I S/O r/o do hereby solemnly affirm and declare as under

That I am a member of the Punjab and Haryana High Court Bar Association.
That my enrollment No is with the Punjab and Haryana Bar Council and Membership no. is of the Punjab and Haryana High Court Bar Association.

Name and full address of the applicant/s:
1. 2.

Name and address of the deaceased Advocate

Relationship of the Applicant/s with deaceased Advocate:-

Date of passing LL.B:-

Enrollment No. with the Punjab and Haryana Bar Council

Enrollment No/Membership no of with the Punjab and Haryana High Court Bar Association :

Subscription of the bar Association paid upto

Whether any disciplinary action was taken against the deceased advocate either by the High Court Bar Association or Bar Council of Punjab and Haryana during the period of his practice:

Date of Death

Whether the deceased adcocate was either suspended removed or debarred from the membership of the Bar Association

If Yes give Details

Place of Death:- (Attach Death Certificate)

Cause of Death:-

Name and addresses of two advocate members of Punjab and Haryana High Court Bar Assication, who knew fully the deceased advocate:-

Any other information which the applicant/s wants to give

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