FSS Application Form

Family Security Scheme, Indian Medical Association Telangana State. Open to IMA Life Members under 60 years of age. Eligible couples join as individual members.

Option 1

Manual submission

Print the form, fill it in block letters, affix a photo attested by the Local Branch Secretary, have the nominees sign, and send it to the FSS office with your cheque or DD and enclosures.

Download Blank Form

Option 2

Fill online

Fill the form below. Use Export PDF any time to download it filled in. Log in to save it, submit it and edit it later.

Fill Online

Applicant details

Name in full

Name of Father / Husband

Date of birth

Sex

Correspondence address

Mobile phone 1 You will need this to check your application status.

Mobile phone 2

Permanent address

Same as correspondence address

Permanent address

Mobile phone 1

Mobile phone 2

IMA membership

IMA Life Member No. of applicant

Local Branch

Nominees

Up to three nominees. Nominees should be major son or daughter (minor accepted only when the member has no major son or daughter). Members up to 35 years may nominate parents. Nominee photo, signature and thumb impression are added on the printed form.

Nominees

Payment

Payment details

Cheque or Demand Draft drawn in favour of APPA FSS IMA TS, payable at Hyderabad.

How will you pay?

Amount (Rs.)

Documents

JPG, PNG or PDF, up to 5 MB each.

Stamp size photograph

Copy of Life Membership Certificate New life members may upload the LM fee receipt or a certificate from the Local Branch Secretary.

Proof of Date of Birth SSC certificate, Passport or PAN copy.

Declaration I, the undersigned, hereby declare that the above information is true and I have not withheld any information whatsoever regarding my particulars. I agree to pay the Fraternity Contributions as and when the bills are sent, as per the rules and regulations of the scheme. I further agree to abide by all the rules and bye-laws of Family Security Scheme IMA TS and any amendments made from time to time in the scheme constitution / bye-laws by MC / FSS Council. I will not proceed legally against FSS without first going to the Arbitration Committee of FSS / IMA TS. I declare that I am not suffering from any terminal illness at the time of joining the scheme. I will promptly inform the FSS office of any change in my address or IMA Branch. If any particulars in this application are found incorrect, my membership can be terminated and the benefits of the scheme need not be paid to the nominees.

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