Indian Academy of forensic medicine

Indian Academy of Forensic Medicine

Registration 349, 12th May, 1972, Panaji, Goa

LM/IAFM: ( No) / ( State) / ( Year)

To,

The General Secretary,

Indian Academy of Forensic Medicine

Dear Sir,

I am life member of IAFM as stated above.

The members’ directory on official website of IAFM has some errors in it and hence I resubmit

The details as under.

Place:………………………… Date:………………………….

Yours faithfully,

Instructions: 1. Particulars to be filled up by the Applicant by TYPING in black colour fonts only.

2. E-mail address shall be in small letters only.

3. After typing details this word document shall be given name as “LM NO ……”

ch saved document in word format shall be sent to “ fm. *****@***com”.

Name in block letters
Date of Birth
Father’s / Husband’s name
Regn. No., Year and name of the council
Permanent address
Present address
Address for correspondence
Mobile No.: Land line Phone: E-mail:
Educational qualification (with name of the University and date of passing)
Present position in the profession

FOR USE OF IAFM

President Gen. Secretary Treasurer