TAMILNADU CONSUMER PRODUCTS STOCKISTS ASSOCIATION

(Chennai Unit Reg.No.270/92)

#2/3 , 4th Street, Judge Colony, Sanatorium,
Chennai-600047. Phone: 9884063063
www.tncpsa.in

Date:

Membership Application Form

To: Passport Size

The Hon.General Secretary Photograph

Dear Sir,

Kindly find enclosed my application for New Free Membership in your

Association, which is duly filled

Yours truly,

Signature of Applicant
With Firm Rubber Stamp

DETAILS

1. Agency Name & Postal :

Address (in BLOCK letters)

Pin Code:

2. Constitution of Agency : Proprietor / Proprietrix / Partnership / Pvt.Ltd.

With Details
3.Distributors for & Areas :
covered

4.Names of Sister Concerns :

(if any)

5.Contact Person Name and

Phone Numbers :

Name :

Office :

Res. Ph. :

Mobile :

Fax :

E-mail :

 Application accepted subject to approval by the Executive Committee.

 Fill-up separate form for sister concerns if any.