HINDUSTHAN CLUB LIMITED 4/1 SARAT BOSE ROAD, KOLKATA 700020. TEL. : +91 33 4017 5555 / 5512. admin@hindusthanclub.com www.hindusthanclub.com CIN No. : U91990WB1946GAP013261 APPLICATION FORM - SWIMMING AFFIX PHOTOGRAPH INDIVIDUAL RECEIVED RS. FAMILY OF TWO RECEIPT NO. FAMILY OF THREE DATE FAMILY OF FOUR APPLICATION NO. W.E.F NAME OF THE CANDIDATE (IN CAPITAL LETTER) DATE OF BIRTH BLOOD GROUP (MANDATORY) (CERTIFICATE MANDATORY) MEMBER’S NAME MEMBERSHIP NO. RELATIONSHIP WITH MEMBER ADDRESS CITY STATE COUNTRY MOBILE NO. PINCODE TEL. NO.  Members are requested to use the facilities ONCE IN A DAY.  All Rules and Regulations of the Club for all facilities and all other status as are normal applicable and more speciﬁcally applicable to this organization shall be binding on all Members.  I desire & take YEARLY Membership.  Yearly charges are applicable irrespective of Membership taken in the anytime of the year.  This facilities of Membership ceases on 31st March of EVERY YEAR.  I have read all the Rules & Regulations & agree to abide by the same. SIGNATURE OF THE CANDIDATE SIGNATURE OF THE MEMBER DATE PRINTED BY : www.abhishekcolors.com - 9830005273 EMAIL ID [DOCTOR'S CERTIFIED TO PHYSICAL FITNESS IS REQUIRED] FOR OFFICE USE ONLY ________________________ SIGN. OF OFFICE STAFF ________________________ SIGN. OF CONVENOR ________________________ SIGN. OF CHAIRMAN ________________________ SIGN. OF HONY. SECRETARY HINDUSTHAN CLUB LIMITED 4/1 SARAT BOSE ROAD, KOLKATA 700020. TEL. : +91 33 4017 5555 / 5512. admin@hindusthanclub.com www.hindusthanclub.com CIN No. : U91990WB1946GAP013261 RULES & REGULATIONS - SWIMMING POOL 1. Timing for Swimming Pool will be as under : a. 6 A.M to 1 P.M b. 2 P.M. to 9 P.M. POOL WILL BE CLOSED FOR MAINTENANCE BETWEEN 1 P.M. TO 2 P.M. c. EXCLUSIVE FOR LADIES & CHILDREN BELOW 16 YEARS 11 A.M. TO 1 P.M and from 2 P.M. to 4 P.M. (Except Saturday, Sunday & Holiday) 2. Entry is strictly prohibited without I.D. Card. Entry for daily users will be on signing of voucher only. 3. Signing of daily register is compulsory for security and safety reasons. 4. Guests utilizing Swimming Pool facilities on daily basis have to be accompanied by a member. 5. Smoking and Chewing of Tobacco/Pan Masala is strictly prohibited on 4th Floor. 6. No eatable for Beverages will be consumed while inside the Pool. 7. Individual with long hair are requested to wear Swimming Pool. 8. No individual will be permitted to use Swimming Pool without Swim Wear. (Shots/Bermuda/Nighties etc. other than Swim Wear are not allowed). 9. In the absence of Life Guard, Pool would remain closed without prior notice. 10. Taking a shower before entering the Pool is compulsory. 11. Individuals intending to avail Locker Facility will be issued keys only depositing the I.D. Card and signing in the register. The card shall be returned on deposit of keys. If the key is not returned a ne of Rs. 100/- will be charged. 12. Club Management will NOT be responsible under any circumstances for any theft/loss of valuables at the Swimming Pool. 13. Members are utilizing Swimming Pool facilities at their own risk and Club Management will NOT be responsible under any circumstances for any injuries or casualty on account of suicide, death etc. 14. No Tubes/Swimming Aid Accessories are permitted inside the Pool except for children below 10 years. 15. Playing with ball etc. inside the Pool is Strictly Prohibited. 16. Individuals suffering from contagious diseases, skin infections etc. are requested to refrain from entering the Swimming Pool. 17. Male children of 5 years and above to use Gents Changing Room. 18. Domestic help (Ayahs/Driver/Maid Servants etc.) are not allowed on the 4th oor under any circumstances. NECESSARY ACTION SHALL BE TAKEN BY THE MANAGEMENT AGAINST ANYONE FOUND VIOLATING THE RULES & REGULATION. SIGNATURE OF THE CANDIDATE