RGLSI CHAPTER

View Pending Member

Supreme Grand Chapter of India

Application for Admission to Membership of

Chapter ST.JOHNS No.2

To be filled up by ALL Candidates

Name in Full	DORAIRAJAN SAMPATH
Address	B-4, GANESH APARTMENTS, 34, D SILVA ROAD, MYLAPORE, CHENNAI, - 600004
Date of Birth / Age	25-04-1959 / 64
Profession or Occupation	EXECUTIVE

To be filled up by Candidates for EXALTATION only

Give Name, Number and Constitution of Lodge / Lodge of which you are, and at any time have been a member, Certificate of good standing from all such Lodge , as well as your Grand Lodge Certificate, must be produced.*.

Give Name, Number and Constitution of Lodge in which Initiated, and DATE of Initiation.	MOUNT , 14 & 06-10-2012
Give Name, Number and Constitution of Lodge in which raised, and DATE of Raising.	, 014 & 01-09-2018
GLC No. and Date of Issue	&

(*These Certificates should be returned to the Candidate after Inspection by the Scribe 'E' of the Chapter)

Date

25-06-2023

Signature of Candidate (Exaltation, Joining or Re-Joining)

Name of the Proposer

E.Comp VENKAT NATARAJAN

Signature of the Proposer

Name of the Seconder

Comp PUVAVADA SRINIVAS

Signature of the Seconder

Certificate of Scribe 'E'

I certify that the above application was read in open Chapter immediately before the ballot was taken

Candidate was exalted in this Chapter on

Name of Scribe 'E'

Comp VENKATESWARAN VISWANATHAN

9444401297

vvassosiates2000@yahoo.co.in

Signature of Scribe 'E'

NOTES

1. This form (propertly filled up) is to be handed over to theScribe 'E' of the Chapter provious to the Convocationat which the proposition is to be made.

2. After verifying the above certificates the Scribe 'E' will retain the application as a Permanent record.