Pediatrician Social Service Society |

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Pediatricians' Social Service Society
Membership Application Form

Are You A Pediatrician Member Or Spouse of Pediatrician ?

Pediatrician
Spouse of Pediatrician

Rules & Regulations

RULES & REGULATIONS

(1) If suffering / suffered any MAJOR disease, then confirmation of membership is subject to approval by Panel (4 Drs' Panel of PSSS) & acceptance of window period by applicant..

(2) Eligibility Criteria: Age < 60 Years, Life Membership of AOP Gujarat.

(3) Death Fraternity Contribution (D.F.C.)

Group	Age (Years)	D F C (Per Death - to be paid)	Total Period for DFC Payment (Years)
A	< 35	1000	20
B	35 to 44	1200	18
C	45 to 54	1500	16
D	55 to 60	2000	14

Annul Maintenance Charge (AMC) to be paid every year for 20 years by each member

(4) Annual Maintenance Fee Rs.1200/-/ time to time decided by board.

(5) Form to be filled up with Birth Date Evidence, Photo, Payment Evidence and Life Membership of AOP Gujarat Certificate.

(6) Nominee will get Rs.800/- x strength of PSSS(Total Number of Members on that date)

Required Documents: (a) Death certificate (b) Original PSSS Membership Certificate (c) F I R, if Accidental Death. (d) Any other Documents, if needed & demanded by Board/Office.

(7) Scheme will be managed by Managing Committee (Board of Directors) and Advisory Board for administration, fund management etc.

(8) Once member is enrolled, he/she will get membership certificate, copy of rules and regulation.

Group	Age (Years)	Admission Fees Rs.	Membership Fees Rs.	Advance D.F.C. Rs.	Total Payment Rs.
A	< 35	3000	1000	3000	7000
B	35 to 44	4000	1000	4000	9000
C	45 to 54	5000	1000	5000	11000
D	55 to 60	7000	1000	6000	14000

December 2020

Rules & Regulations (Non-PSSS)

RULES & REGULATIONS

(1) If suffering / suffered any MAJOR disease, then confirmation of membership is subject to approval by Panel (4 Drs' Panel of PSSS) & acceptance of window period by applicant..

(2) Eligibility criteria: Age < 60 Years

(3) Death Fraternity Contribution (D.F.C.)

Group	Age (Years)	D F C (Per Death - to be paid)	Total Period for DFC Payment (Years)
A +	< 35	1200	20
B	35 to 44	1200	18
C	45 to 54	1500	16
D	55 to 60	2000	14

Annul Maintenance Charge (AMC) to be paid every year for 20 years.

(4) Annual Maintenance Fee Rs.1200/-/ time to time decided by board.

(5) Form to be filled up with Birth Date Evidence, Photo, and Payment Evidence

(6) Nominee will get Rs. 800/- x strength of PSSS (Total Number of Members on that date)

Required Documents: (a) Death certificate (b) Original PSSS Membership Certificate (c) F I R, if Accidental Death. (d) Any other Documents, if needed & demanded by Board/Office.

(7) Scheme will be managed by Managing Committee (Board of Directors) and Advisory Board for administration, fund management etc.

(8) Once member is enrolled, he/she will get membership certificate, copy of rules and regulation.

Group	Age (Years)	Admission Fees Rs.	Membership Fees Rs.	Advance D.F.C. Rs.	Associate Membership Fee	Total Payment Rs.
A	< 35	3000	1000	3000	1000	8000
B	35 to 44	4000	1000	4000	1000	10000
C	45 to 54	5000	1000	5000	1000	12000
D	55 to 60	7000	1000	6000	1000	15000

December 2020

Group Details

DATE OF BIRTH*

Membership Fee

Membership Group

Personal Details

First Name *

Middle Name (Name of Father/Husband)*

Last Name *

Central IAP membership *

AOPG membership No. *

Upload Photograph * Allowed formats: JPG, JPEG, PNG(Max size: 2MB)

Address *

City *

Postal Pin Code *

Mobile Number *

Alternate Mobile Number

Gender *

Identity Details

Aadhaar Card Number *

PAN Card Number *

Upload Aadhar Card *

Allowed formats: JPG, JPEG, PNG, PDF (Max size: 2MB)

Upload Birth Date Certificate(PAN Card/ School Leaving/ Passport/ Driving Lic.) * Allowed formats: JPG, JPEG, PNG, PDF (Max size: 2MB)

Upload Marriage Evidence Documents *

Allowed formats: JPG, JPEG, PNG, PDF (Max size: 2MB)

Medical Information

Suffering from any MAJOR disease? *
YES NO

Qualification

Enter Qualification *

Nominee 1 (Mandatory)

Nominee Name *

Relation with Member *

Date of Birth*

Guardian Name & Relationship (If Minor)

Nominee Photograph * Allowed formats: JPG, JPEG, PNG(Max size: 2MB)

Nominee 2 (Optional)

Nominee Name

Relation with Member

Date of Birth

Guardian Name & Relationship (If Minor)

Nominee Photograph Allowed formats: JPG, JPEG, PNG(Max size: 2MB)

Additional details

1st Contact Pediatrician's Name

Address :

Contact

E-mail

2nd Contact Pediatrician's Name

Address :

Contact

E-mail

PSSS No. of Main Member * PSSS No. of Proposer*

Pediatricians' Social Service Society
Membership Application Form

Are You A Pediatrician Member Or Spouse of Pediatrician ?

Do You Have An AOPG Number?

Enter PSSS Number Of Spouse Pediatrician

Group Details

Personal Details

Identity Details

Medical Information

Qualification

Nominee 1 (Mandatory)

Nominee 2 (Optional)

Additional details

Pediatricians' Social Service Society Membership Application Form

Are You A Pediatrician Member Or Spouse of Pediatrician ?

Do You Have An AOPG Number?

Enter PSSS Number Of Spouse Pediatrician

Group Details

Personal Details

Identity Details

Medical Information

Qualification

Nominee 1 (Mandatory)

Nominee 2 (Optional)

Additional details

Pediatricians' Social Service Society
Membership Application Form