On a Hundred Rupee Stamp paper
COMMON
The Form of Undertaking to be furnished by the person,
on whom the prospective Non-Earning Member is dependent
for discharge of liabilities to the Society.
To,
The Chief Promoter/Secretary
______________________________________Co-op. Housing Society Ltd.,
______________________________________
______________________________________
Sir,
Shri/Smt. / _____________________________________________________________________
had made an application for membership of the _________________________________ Co-operative
Housing Society Ltd., having address at
______________________________________________ _____________ He / She has no independent source of income and is dependent on me.I,
therefore, undertake the discharge all the liabilities, present and future, payable him/her admission to
membership of the society, on his/her behalf as communicated to me directly or though him/her
from time to time, by the Society. On failure of such discharge in respect of dues. I shall also be liable
for recovery u/s. 101 of the MCS Act, 1960, alongwith the said member who is dependent on me.
My details are given below :
(1) Name : ____________________________________________________________
(2) My address : ____________________________________________________________
(a) Office : _________________________________
(b) Residence : _________________________________
(c) Telephone No. : _________________________________
(3) Occupation : _________________________________
(4) Name & full address of the employer : _____________________________________________
(5) Monthly Income : _________________________________
Place : Yours faithfully,
Date :