An Industry Incubator under PPP Mode with Ministry of MSME

Government of India

MEMBERSHIP FORM

Full Name___________________________________________________________________________________
Photo
Date of Birth DD MM YY

Mailing Address______________________________________________________________________________

__________________________________________________________________________________________

Mobile No.__________________________ Whatsapp No.____________________________

Email id.____________________________ Website_________________________________

Name of the Existing Organisation________________________________________________________________

Designation _________________________________________________________________________________

Nature of Business of existing Enterprise_________________________________________________________

Purpose of Incubation New Business Connect Knowledge

Membership plan

General Plan – For Individual/Enterprises/Startups

Incubatee Membership Fee Rs. 2360/-
Executive Membership Fee Rs. 5900/-
Associate Membership Fee Rs. 11800/-
Corporate Membership Fee Rs. 59000/-

Professional Plan – For Institution/Suppliers/Experts

Associate Membership Fee Rs. 11800/-
Corporate Membership Fee Rs. 59000/-

The above membership fee amount is inclusive of GST calculated @ 18%

The information given above is true to our knowledge. We agree to inform you in writing of any change in the particulars stated above.
We have read and understood the terms and conditions and agree to abide by the same.

Dated: Signature with rubberstamp

*Membership once issued is non refundable

Payment may be made by Cheque or Demand draft, drawn in favour of “Institute for Industrial Development”
For online payment/RTGS: Institute for Industrial Development, Union Bank of India,
U.P. Rural Housing Board Branch, Lucknow,
CA No. 521301010036458 IFSC Code – UBIN 0552135
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MSME Helpline: 7408733333, 7607655555 Email us: support@iid.org.in

Delhi Office: Multi Disciplinary Training Center, Gandhi Darshan, Rajghat, New Delhi 110002
Lucknow Office: Samadhan Tower, 27/B/1, Gokhley Marg, Lucknow (UP) 226001