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Intent Form for Issuing Duplicate I-card
Date :
    Mumbai-400 064.
Field marked with * are compulsory
Name :

(First name)*

(Middle name)
Telephone number : *
Mobile number :
Email-id : *
Address : *
 Ref : Membership No.: *
Dear sir,
Please issue me a duplicate I-card for the the reason stated below.
     Reason :   *
  Rs. 150/- as processing charges. (Rs. 300 in case of Lost)
  3 Latest colour photographs (size: 30mm X 35 mm with red Background)

I assure that I do not preserve the earlier card/s. If I found the same I will surrender it to club immediately to avoid the misuse of the card. If it is found that card is misused by me. I agree to pay fine of Rs.2000/- for the same.

 I agree all the "Rules and Regulations" of Goregaon Sports Club and I will abide by them.

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