1. I/We/Shri/Shrimati/Messrs ................................ are a member of the .................................. Co-operative Housing Society Ltd, having address at ....................................

2. I hold the share certificate no......................... dated .................... fully paid up shares of Rupees fifty each, bearing number from ................. to ..................... (both inclusive), issued by the said society to me.

3. I also hold the Flat No ................................ admeasuring .......................... Sq. metres, in the building of the said society, numbered known as ..............................

4. As provided under Rule 25 of the Maharashtra Co-op. Societies Rules, 1961, I hereby nominate the person/s whose particulars are as given below

Sr.No.	Name/s of the Nominee/s	Permanent Address of the Nominee/s	Relationship with the Nominator	Share of each nominee (Percentage)	Date of Birth of nominee/s if the nominee/s is a minor
1	2	3	4	5	6
1
2
3
4
5

5. As provided under Section 30 of eh Maharashtra Co-operative Societies Act, 1960, and the Bye- laws No. 34 of the Society, I state that on my death the Shares mentioned above and my interest in eh flat, the details of which are given above, should be transferred to Shri/ Shrimati..................................... the first named nominee, on his/her complying with the provisions of the Bye-laws of the society regarding requirements of admission to membership and on furnishing Indemnity Bond, alongwith the application for membership, indemnifying the society against any claims made to the said shares and my interest in the said flat by the other nominee/nominees.

6. As the nominee at Sr. No.......................................... is the minor. I hereby appoint Shri/Shrimati................................................... as the guardian/legal representative of the minor to represent the minor nominee in Matters connected with this nomination.

Place:
Date:

Witnesses:-
Name and Addresses of Witnesses
1) Shri/Shrimati .........................................	1) Signature of the Witness
Address .........................................
2) Shri/Shrimati ........................................	2) Signature of the Witness
Address .........................................

The nomination was placed in the meeting of the managing committee of the society held on .................................................... for being recorded in it minutes.
The nomination has been recorded in the nomination register at Sr. No.....................................

Place:
Date: