Animal Welfare Board of India

(Ministry of Environment & Forests, Govt. of India)

Post Box No. 8672

13/1, Third Seaward Road, Valmiki Nagar, Thiruvanmiyur, Chennai - 600 041.

E-mail : awbi@md3.vsnl.net.in       Website : www.awbi.org

For office Use Only

Date of Receipt :         Date of Issue of I.D. Card :                       I.D. Card No.:

 

Application for Hony. Animal Welfare Officer

 

Name                        :

(In Block Letters)

 

Address                     :

 

                                

                                           Name of Sponsoring

                                           Organisation with

Pin-Code:                                                                AWBI Recog. Code No.

 

Residence Telephone  :

Work Telephone          :                                                             Address:

Age:

Sex:                                                                                       

Give a brief description of the sponsoring organisation’s

activities, facilities and kinds of animals handled.

What is your involvement with this organisation?

Have you attended any animal welfare training programme?         

If sponsored by AWBI, please attach a

copy of certificate attested by a Gazetted Officer

How long have you been with this Organisation?

Educational Qualifications?

What is your previous involvement with Animal Welfare?

Which languages do you speak?

Languages                                Speak                                                Write

                                               good/fair/poor                                      good/fair/poor

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I enclose a Bank Draft Payable at Chennai in favour of “Animal Welfare Board of India” for Rs.100/- as registration fee. (DD No................ dt................. Name of the Bank........................................................... Bank Code.......................)

Signature of applicant:

Date:

Signature of Secretary/President of the

sponsoring Organisation with seal and

name in block letters 

 

 

Date:

 

Please return this form to Secretary, Animal Welfare Board of India, 13/1, Third Seaward Road, Valmiki Nagar, Thiruvanmiyur, Chennai - 600 041.  Tel. No. 044-24454958, 044-24454935 Fax No. 044-24454330

 

* Note :       Please send one additional passport size photograph.

 

 

 

                                                                                 

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