Monday, November 18, 2013


                                               YOUR ADVOCATE LAW ACADEMY
                                                                AFFILIATED TO

                                                                  BIBLE MEDICINE MINISTRIES’

          Please Return to: Dr. Stephen Louie     Email:

                                                             APPLICATION FORM  
APPLICATION CATEGORY: For Ofiice Use :Doctor of Cosmic Law  (CLD)qA / Hon. Ph. D- B.B /Peace ADRS q B /Others q C

Applicant’s  Being Proposed by  :                                                                Seconded  by :
Name of the applicant
Gender /   Date of Birth/ Age
Profession  /    Identity   

Father’s / Husband’s Name:

ID No. with validity:

Address : Res.:                                                                                         Off.:
Tel : Res.                                  Off:
Fax :                                       Off:
E-mail  & Website if any :                                                                                            
Amount of Contribution : D.D / Cheque  bearing No. -----------------------dtd------------------for  $/Rs. -------------------------            
Year of establishment/ Experience :

Occupation if not a  Professional   :

Which of the following activities are you engaged in?
(Please mark ‘X’ in front of desired options)
1. Mediation                 2. Arbitration       3.       Advocacy           4. Counselling     

5. Consultation          6.  Preaching       7.  Teaching      8. Church Activities 

9. Other religious Activities       10. Peace  Making        11.Any Other ---------------------

Your Citizenship/ Nationality   : 

Do you hold any other Hon. Doctoral Degree ?  If YES , Details:

B. Ministerial /Professional / Arbitration/Mediation/Conciliation
                 Membership: 1.Arbitration Council / Association/   2. Church      / 3.  Any Other ---------------------------------

_______________________________________                                                                                                          _______________________________________             _______________________
  ____________________________________                      _______________

  1.  Do you like to take our Membership of the Academy, which is a prerequisite for the Online /Correspondence Course by paying Rs. 200/
    (If so, please indicate your Intention and how you knew of our “Your Advocate Law Academy” .)


C. Qualification :

  1. Where & How did you complete your Education  ?
    (Please indicate the Name of the College / Board / University.)

Name:                                                                                          Place:
1._____________________________________                      _______________
2._____________________________________                      _______________
3._____________________________________                      _______________
4._____________________________________                      _______________

Your  PHOTO 

  1. Which of the following  do you like  for Doctor of Cosmic Law / Ph. D in B.B ARDS /ADRS &Peace?

q   Thesis Writing  q Attending  Classes  q By Credit Transfer  q  Accomplishment q Other Ways
Preference to be noted here:
Whether supporting Documents Enclosed:   Yes / No . Kindly List them out :

Signing  hereunder  you do confirm and declare  hereby  that .you are abiding by the Rules & Regulations of
the Trust/s and the Academy dealing  with offering Education and  Certification pursuant to Law  sans any obligation  and reservation whatsoever and that you are making a non refundable contribution of Rupees (YOUR Suggestion welcome ) by D.D./Cheq./ bank transfer/  via paypal favouring “------------------------------------------------------------------------------------------------------------------------------------------, payable at Chennai towards propagation of  Liberal Education to all ,subject to Laws of the Countries and States
Self Declaration : .
Confirming all  those  stated above by me  to be true to the best of my knowledge and faith   I agree to all the above Terms  and Conditions of the Academy /Trusts pertaining to my  Title / Degree.
                          Dated ------------------------Day of ----------------20-------at ----------------------------                                                                                                                                                


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