Pimpri chinchwad chamber of Industries,
Commerce, Services and Agriculture
Plot No. 64/11, d-2, Block, MIDC, Chinchwad, Near Sanghavi College,
Pune - 411019. Phone: 020 - 66111771, Fax: 020 - 46221209
E-mail: info@pccicsa.com Web : www.pccicsa.com

MEMBERSHIP APPLICATION

To,
The President, P.C.C.I.C... & Ag
Plot 64/11, D-2, Block, Midc, Chinchwad,
Near Sanghavi College, Pune - 411019.

Dear Sir,

I/WE here by apply for Trustee/Managing Committee/General Membership of Pimpri Chinchwad Chamber of Industries, Commerce, Services and Agriculture on behalf of our Association/Company/Individual with the particulars as follows:

1. Name of Applicant: M/S. / Mr. Mrs. / Smt.: *
2. Status:  
   Individual Proprietor
3. Address:  
4. Ph. No.:  
5. Mobile No: *
6. E-mail: *
7. Website:  
8. If Association / Company / Authorized Person’s Name: *
9. Designation Of Applicant:  
10. Name of Company / Association: *
11. Office Address of Applicant:  
12. Ph.:  
13. Mobile: *
14. E-mail: *
15. Residence Address of Applicant:  
16. Ph.:  
17. Mobile: *
18. E-mail: *

19. ---

    To KNOW ABOUT YOUR BUSINESS
    
    
20. NAME OF COMPANY: Partnership / Prop. / Pnt. Ltd. / Ltd.: *
21. NAME OF BUSINESS: *
22. OFFICE ADDRESS:  
23. PHONE:  
24. MOBILE: *
25. BIRTH DATE: *
26. DURATION OF BUSINESS:  
27. AGE:  
28. YEAR:  
29. SEX:  
    MALE FEMALE
30. EDUCATION QUALIFICATION: *
31. YEARLY TURNOVER OF YOUR COMPANY: *
32. NO. OF EMPLOYEE: *
33. NO. OF UNITE / FACTRIES: *
34. YEARLY TURNOVER OF YOUR GROUP OF COMPANIES: *

35. ---

    DETAIL ABOUT YOUR ASSOCIATION
    
    
36. FULL NAME OF ASSOCIATION: *
37. NATURE OF ACTIVITIES: *
    Industrial Commercial Services Professional
38. REGISTRATION NO.: *
39. DATE OF FORMATION: *
    MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
40. JURISDICTION: *
41. NUMBER OF MEMBERS: *
42. KIND OF REGISTRATION:  
    MSI SSI TINNY Regd. Co-op. Society.

43. ---

    Association must have registration under co. operative Societies Act & Public Trust Act
    

44. ---

    VERIFICATION BY THE APPLICANT: I/WE, Do hereby declare that whatever stated herein above is true to the best of my / our knowledge and belief. I/WE also undertake to abide by the Rules, Regulations And Constitution of Pimpri – Chinchwad chamber of Industries, Commerce, Services and Agriculture. The amendments and changes in constitution, Rules & Regulations time to time shall be on me / us and our Association.
    
    

    1) The Executive Board Of Trustees Shall Be The Final Authority To Accept Or Reject The Mambership Applications.

    2) There Are Three Kinds Of Membership And Accordingly The Yearly Subscription Is As Under
                  a) For Trustee Membership                              P.A. Rs. 25,000/-
                  b) For Managing Committee Membership          P.A. Rs.   5,000/-
                  c) For General Membership                              P.A. Rs.   2,000/-

    3) In Case Of Trustee Membership Applicant From Industry Sector Shall Enclose Proof Of Unit/Units, Certified Balance  Sheet Copy, Classification Of Unit MSI/SSI/Prop./P.Ltd. / P.Pvt. Ltd.

    4) In Case Of Trustee Membership Applicant from Commerce, Traders, Exporters, Importer, Services Providers The Certified Copies Of Central, State, Semi-Govt. Corporation, Nagarpalika, Village Panchayat, Pcntda, Licences And Permissions Eligible For Concerned Activities Are Required.

    5) The Managing Committee Membership Purpose The Documents Mentioned Above Are Applicable.

    6) The General Membership Applicants Shall Enclose MSI/SSI Licence And Status Proof Certified Copies.

    7) If the Yearly Subscription Is Not Paid For Two Conseentive Years Membership Will Automatically Stand As Cancelled.

    8) The Managing And General Members Have No Right Of Voting For Executive Board Of Trustees. The Executive Board Of Trustees Shall Be Elected By Trustee Members Only.

    9) The Company or Association Shall Represent Through Their Authorized Representative for Trustee, Managing Committee And General Membership.

    10) The Yearly Subscription For Each Class Of Membership Shall Be Increased By The General Body Of Trustees Whenever They Found Proper To Achieve The Object Of Chamber.

    11) The Membership Shall Not Be Allowed To Any Social An D Political Parties, Labour Union.

    12) If The Associations Of Manufacturers, Traders, Commerce, Services, Professional Shall Submit Public Trust Registration, Co-Operative Act Registration   Certified Copies and Resolution for Membership And Name Authorisied Person.

    13) Any Other Terms and Conditions Other Than Above Shall Be Binding On Applicant Decided By Executigue Board Of Trustees Time To Time.

    14) The Membership Shall Be Allotted On Receipt Of Payment Only.

    15) The Duly Completed Form With All Necessary Documents Shall Be Accepted Otherwise Will Be Rejected.

    16) Three Passport Size Photographs Necessary.
    
    

45. I/WE, ACCEPT THE TERMS AND CONDITIONS OF MEMBERSHIP  
    Agree
    
46.