1[FORM I
[Rule 4(2)]
MEMORIAL

1. Subs. by G.S.R. 870(E), dated 8-7-97 (w.e.f. 8-7-1997.
1. Name of the applicant _____________________________     
2. Father’s name ____________________________________  
3. Address (residence)_______________________________    
Pin _____________________________                         
Telephone ___________ Fax ___________                    
4. Address (office) _________________________________     
5. Educational qualifications (Please attach photocopies) ____________________
6. Date of enrolment (Please attach photocopies) ___________________________
7. Practising in           : ________________________________________________
 Civil side                  : _______________________________________________
 Criminal side            : _______________________________________________
 Taxation                   : ______________________________________________
 Revenue courts        : ____________________________________________________
8. Whether income tax assessee:
The memorial of (name of the applicant) showeth _________ (in block letters) ______
1. that the memorialist is a person eligible for appointment as a notary under the Notaries Act, 1952 and clause (a) of rule 3 of the Notaries Rules, 1956;
2. that the memorialist resides in ____________________ (here state the name of the local area or name of court where he intends to practise) and will reside for upwards of ____________ (state how long);
3. that the number of notaries practising in the local area is insufficient for the requirements thereof (the grounds of the statement should be added);
4. that no previous application of the memorialist has been rejected or withdrawn by him, within the preceding six months;
The memorialist, therefore, prays that the government be pleased to appoint and admit him as a notary under and by virtue of the Notaries Act, 1952 (53 of 1952) and clause (a) of rule 3 of the Notaries Rules, 1956 to practise in _______ (here state the name of the local area).
Dated __________ day of ________200_____ Signature of the applicant
Name and address of               Profession                    Name and address of                Signature                      signatories the firm / organisation
Note:-             Under rule 4(3) the memorial should be countersigned by a Magistrate, a manager of a nationalized bank, a merchant and two prominent inhabitants of the area where he intends to practise as a notary.]