Membership Application Form

Federation of Tax Practitioners of Tamilnadu

Please fill in all sections (A through G) accurately. Upload your passport photo and supporting documents before submitting.

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SCAN & PAY APPLICATION FEE Official UPI Gateway

Federation of Tax Practitioners

Scan using any UPI App (GPay, PhonePe, Paytm, BHIM, CUB) to transfer your membership admission & subscription fee.

UPI ID: EZE0444385@CUB

City Union Bank (CUB) — Thillainagar, Trichy

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DISTRICT *

MEMBERSHIP CATEGORY *

Ordinary Life Associate Other

PERSONAL & CONTACT DETAILS

Full Name *

Father's / Spouse's Name *

Date of Birth

Blood Group

Residential Address *

Applicant Photo *

Passport Size (JPG/PNG, Max 5MB) *

WhatsApp Number *

Alternative Mobile

Email Address *

PROFESSIONAL DETAILS

Firm / Office Name

Designation / Status

Professional Address

Years of Practice

Chapter / Association

Reference / Proposed By

Professional Qualification

Other Qualification

PAN Number *

Aadhaar Number (Optional)

GSTIN (Optional)

TAX / PROFESSIONAL REGISTRATIONS

Provide registration details for any applicable tax practitioner category:

Qualification / Wing	Registration No.	Year	Experience
STP Sales Tax Practitioner
VAT Value Added Tax
GSTP GST Practitioner
ITP Income Tax Practitioner
CTPr Commercial Tax Practitioner

NOMINEE DETAILS

Nominee Full Name

Relationship with Applicant

Nominee Date of Birth

Nominee Mobile Number

Nominee Residential Address

Members Count in Family

DOCUMENTS ENCLOSED

PAN Card Copy PDF or Image (Max 5MB)

Aadhaar Card Copy PDF or Image (Max 5MB)

STP Certificate Sales Tax Practitioner Certificate

VAT Certificate Value Added Tax Certificate

GSTP Certificate GST Practitioner Certificate

ITP Certificate Income Tax Practitioner Certificate

CTPr Certificate Commercial Tax Practitioner Cert.

Other Tax Certificate Combined / Other Tax Certificate

Professional Qualification Certificate Degree / LL.B / CA / Diploma Copy

Address Proof Electricity bill / Rent agreement / Gas bill

Payment Confirmation / Transfer Receipt (Screenshot / PDF)

Attach your membership fee transfer screenshot, bank payment receipt, or transaction confirmation image/PDF.

Upload UPI Screenshot / Bank Counterfoil / Transfer Slip (PNG, JPG, PDF, Max 5MB)

WELFARE / INSURANCE DETAILS (Optional)

Height

Weight

Insurance / Policy No.

Remarks

DECLARATION & UNDERTAKING

I hereby declare that the information furnished by me in this Membership Application Form is true and correct to the best of my knowledge and belief. I agree to abide by the Rules, Regulations, Bye-Laws and Code of Conduct of the Federation of Tax Practitioner's, Tamilnadu, and undertake to maintain the dignity and professional standards of the Federation.

CONFIDENTIALITY NOTE: Personal information submitted in this application will be handled with strict confidentiality for official membership, state statutory, and welfare administration.

Place *

Date *

I Accept & Confirm Declaration *

Security Check *

Required

Please solve the simple arithmetic calculation below to verify that you are a genuine human applicant.

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