APPLICATION FORM

member

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

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. 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,
Date

(Signature)

Name
Designation
Organisation

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

02 01

Proposed by

Signature
Name
Designation
Company
City

Seconded by

Signature
Name
Designation
Company
City

Confederation of Indian Industry

Address

APPLICATION FORM

member

(Please fill in block letters)

1. Name of the organisation / company

2. Name and designation of Chief Executive

3. Name and designation of principal representative

for liaison with CII

(If you have other offices in India/abroad,

please attach their complete addresses)
4. Address

Phone :

Fax :

Email :

Website :

5. Type (indicate)

Manufacturing

Service

Foreign

Multinational

6.

Sector (indicate)

Public Central

Public State

Public Limited

Private

(Public means a State/Central Government undertaking)

Joint Venture (% of foreign holdings)

(Please name the foreign partners)

7. Scale (indicate)

Large

8. Indicate the CII Division(s) you would like to join

Medium

Small

9. Company data
(a) Capital employed

Rs.

(b) Sales turnover (last two years)

Rs.

in year

Rs.

in year

(c) Total no. of Employees

Permanent

Temporary

(d) Export

Product Description

Export to countries

(e) Import

Product Description

(f) Year Established

(g) CIN Number

Import from countries

Standard

Collaboration

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

(a)

Our cheque/DD No .
dated
Confederation of Indian Industry is enclosed.
Encl:

1.
3.
5.

:
Entrance fee : Rs.

(b) Membership fee : Rs.

for Rs.

Drawn on

Latest Annual Report / Balance sheet / Audited Accouts

Registration certificate as per MSME Act or a certification by the auditors / authority
List of Key Management Personnel

favouring

2.
4.
6.

Company Profile
Note on your expectations from CII
DD / Cheque

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

Signature

Name

Date

Designation

FOR CII OFFICE USE ONLY

RC Meeting Approval Date : __________________
MEMBER CODE

ER

NR

SR

WR

Confederation of Indian Industry

Investment in plant & machinery for Mfg companies

Investment in Equipments for Services companies