FORM NO.NCLT.10
(see rule 46)
APPLICATION FOR THE REGISTRATION OF A INTERN OF AUTHORISED REPRESENTATIVE UNDER THE RULES
1. Name of Authorised Representative referred under these rules on whose behalf the intern is to be registered.
2. Particulars of the intern to be registered
| (i) | Full name (in capitals) | |
| (ii) | Address with contact no. and valid email address: | |
| (iii) | Father’s name | |
| (iv) | Age and date of birth | |
| (v) | Place of birth | |
| (vi) | Nationality | |
| (vii) | Educational qualifications | |
| (viii) | Particulars of previous employment, if any | |
| (ix) | Proof of Identity |
I,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (intern above named), do hereby affirm that the particulars relating to me are true.
3. Whether the authorised Representative has a intern already registered on his behalf and whether the intern sought to be registered is in lieu of or in addition to the intern already registered.
4. Whether the intern sought to be registered is already registered as a intern of any other Authorised Representative and if so the name of such practitioner
I, . . . . . . . . . . . . . (Authorised Representative) and Practicing as . . . . . . . . . Bearing Registration No . . . . . . . . . on the rolls of . . . . . . . . . At . . . . . . . . . , having office at (address with contact no and valid email) . . . . . . . . . and residing at . . . . . . . . . certify that the particulars given above are true to the best of my information and belief and that I am aware of any facts that any unethical and immoral attitude or behavior or character of the above intern if found would lead to cancellation of the registration of the said …. (name) as a intern without any notice.
Date:
Place:
Signature of Authorised Representative
To
The Registrar of the Tribunal
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