APPLICATION FORM

associate
member

(Please tick whichever is appropriate)

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)
Prof C K Prahalad Centre
98/1, Velachery Main Road
Guindy, Chennai - 600032

The Regional Director

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

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

02 01

Proposed by

Signature
Name
Designation
Company
City

Seconded by
Signature
Name
Designation
Company
City

Confederation of Indian Industry

N.B. : This application should be proposed and seconded by two existing CII members (Authorised Signatory with Company stamp).

APPLICATION FORM

associate
member

(Please fill in block letters)

1.

Name of company/organisation

2.

Address of India liaison office

:
Telephone :
Fax :
E-mail :

3.

Chief Executive

4.

Designation

5.

Year established

6.

Contact person for liaison with CII :

7.

Designation of contact person

8.

Address of contact person

9.

Data of parent company

Website :

a) Turnover US$ :

c) Employment :
10. Activities/Services of parent company (Please give details):
11. Involvement in trade Joint Venture technologies (Please furnish full details on a separate sheet)

12. Company's expectations from CII in terms of services

FOR APPLICANT'S INFORMATION

Entrance

(to be sent along with Application Form)

Rs 10,000/-

We hereby give our consent to abide by the Rules and Regulations of the Confederation.
Annual Membership Subscription Rs 50,000/Name

Date

Designation

Note

Signature

Please attach :
I. Last annual report and audited accounts of the parent company.
II. Copy of the approval from Reserve Bank of India.

(Service Tax 14% extra towards

annual subscription and entrance fee)

Fee

An Associate Member will not be eligible to stand for election to any elected body of the Confederation and
shall also not have the right to vote.

Confederation of Indian Industry

b) Investment US$ :