Confederation of Indian Industry

APPLICATION FORM
(Please tick on the basis of location of your primary establishment)

member
The Regional Director Confederation of Indian Industry (Western Region) 105, Kakad Chambers 1st floor, 132, Dr Annie Besant Road Worli, Mumbai - 400 018

The Regional Director Confederation of Indian Industry (Northern Region) Block No 3, Dakshin Marg Sector 31-A Chandigarh - 160 047

The Regional Director Confederation of Indian Industry (Eastern Region) 6, Netaji Subhash Road Kolkata - 700 001

The Regional Director Confederation of Indian Industry (Southern Region) 98/1, Velachery Main Road Guindy, Chennai - 600032

Dear Sir, We wish to apply for CII Membership. The Application Form, duly completed, is submitted along with the relevant supporting documents. Kindly acknowledge receipt of the above and confirm our Membership. Yours faithfully, (Signature) Date

Name Designation Organisation Address

N.B. : This application should be proposed and seconded by two existing CII members.

02 01

Proposed by

Signature Name Designation Company City

Seconded by

Signature Name Designation Company City

Confederation of Indian Industry

Confederation of Indian Industry

APPLICATION FORM
(Please fill in block letters)

member

1. Name of the organisation / company 2. Name and designation of Chief Executive 3. Name and designation of principal representative for liaison with CII

: : :

Phone : (If you have other offices in India/abroad, please attach their complete addresses) 4. Address Email : :

Fax : Website :

5. Type (indicate) 6.

Sector (indicate)

Manufacturing Public Central

Service Public State

Foreign Public Limited

Multinational Private

(Public means a State/Central Government undertaking)

Joint Venture (% of foreign holdings) (Please name the foreign partners)

7. Scale (indicate)

Large

Medium

Small

8. Indicate the CII Division(s) you would like to join : (CII Divisional Membership is optional for Manufacturing Companies on additional fee) 9. Company Data (a) Capital employed Manufacturing (Investment in Plant & Machinery) Service Sector (Investment in Equipments) (b) Sales turnover (last two years) : : : Rs. Rs. Rs. Rs. (c) Total No. of Employees 10. Major Activities (a) Manufacturer of (b) Agents of (c) Services rendered 11. How do you expect to benefit from CII membership? (Attach separate sheet, if necessary) 12. Payment details Our cheque/DD No. of Indian Industry is enclosed. Encl: 1. 3. 5. dated : : : : (a) for Rs. Entrance fee : Rs. Drawn on 2. 4. 6. Company Profile Note on your expections from CII DD / Cheque (b) Membership fee : Rs. favouring Confederation : Permanent in year in year Temporary

Latest Annual Report / Balance sheet / Audited Accouts Certificate of Registration, if SSI List of Key Management Personnel

We hereby give our consent to abide by the Rules and Regulations of the Confederation.

Signature Date

Name Designation

FOR CII OFFICE USE ONLY

RC Meeting Approval Date : __________________ MEMBER CODE ER NR SR WR

Confederation of Indian Industry