[See sub-rule (1) of rule 3]
Application for registration of a Multi-State Cooperative Society under the Multi-State Cooperative Societies Act, 2002

The Central Registrar of Cooperative Societies,
New Delhi.

We submit herewith a proposal for registration of the following Multi-State Cooperative Society along with enclosures as indicated below :

2. We also declare that the information given herewith including that in the enclosures is correct to the best of our knowledge.
(a) Name of the proposed Multi-State Co-operative Society;
(b) Headquarters and address to be registered;
(c) Area of operations;
(d) Main objectives;
(e) Why is it absolutely necessary for the society to be registered under the Multi-State Cooperative Societies Act,2002;
(f) A certificate in respect of provisions of clause (b) or sub-section(1) of section 7;
(g) A certificate in respect of provisions clause (c) of sub-section (1) of section 7;
(h) A certificate in respect of provisions of clause (d) of sub-section (1) of section 7;
(i) If all the members are individuals, indicate the number of persons from each State who have signed the application : Name of the State Number of persons who have Signed the application
(j) Name and address of the applicant for the purpose of further correspondence.

3. Following documents are enclosed :

(a) A certificate from the _______________ Bank stating credit balance there in favour of the proposed multi-state cooperative society.
(b) A scheme explaining how the proposed multi-state cooperative society has reasonable prospects of becoming a viable unit. We are sending herewith four copies of the bye-laws duly signed.

4. Following persons are authorised to sign the bye-laws and also to make necessary alteration therein.

5. The particulars of the applicants are given here under :
S. No. Name If representing a corporate body,
name of the institution*
If the applicant is an
Age Nationality
(1) (2) (3) (4) (4A) (4B)

Profession Name of the State Address Amount subscribed
to share capital
In the case of representative of society or
a multi-state cooperative society, whether
he is Chairpersons/ President or
Chief Executive of that society
(4C) (5) (6) (7) (8) (9)
For Official Use

Received by registered post on+ _________________ by+ ____________ in the office of the Central Registrar, or by hand from Shri+ _______________ entered in the register of application at S.No. _______________ .

Signature of officer receiving

Received registration proposal No. ______________ on ___________ for registration of _______________ Society Ltd., (Proposed) alongwith the enclosures referred to above from ______________ by post/hand deliver.

Place _____________
Date _______________
Central Registrar
Signature and Stamp

* If representing a co-operative or any other co-operative body enclose a copy of the Resolution or authorization of the competent authority, authorizing the person to sign the application for registration.
+ blanks to be filled in.