KANJIKODE INDUSTRIES FORUM MEMBERSHIP APPLICATION FORM We/I hereby submit our/my application form for Membership at Kanjikode Industries Forum as follows: 1 Name of the Industrial Unit 2 Address in full 3 Tel Nos. (Office) 4 Tel Nos. (Factory) 5 E Mail 6 WebSite 7 DIC Registration No. and Date 8 Unit Clasification Micro / Small / Medium/Large 9 Nature of Unit Proprietary/Partnership/Pvt Ltd/Ltd/Co-Op.Society 10 Date of Establishment 11 Type of Industry 12 Name of Chief Promotor Designation Mobile No. 13 Name of Authorised person to represent the unit in the KIF Designation: Mobile No. □Electrical/Electronics □ Mechanical □Civil □Food □Cosmetics □ Agriculture □ Metal □Pharmaceutical □Other:__________________________________ DECLARATION I hereby declare that the information given above are true and correct to the best of my knowledge. I have read and understood the bye-laws and rules governing Kanjikode Industries Forum (KIF) and I shall abide by them. I shall do my best to promote the objectives of KIF. I am remitting Rs.2,500/- being my Life Membership fee in cash/cheque, No……………………… dated……………….... I request you to admit my unit as a member of KIF. I also agree to pay Rs.100 per month’s subscription fee. The person representing our unit in the forum shall be – Name : Mr./Ms. Designation : In case any change is effected in the representation, the same shall be communicated to the forum in writing. Signature of the Authorized Representative :____________________________________ Signature & Stamp of Chief Executive : _________________________________________ Place: Date: =========================================================================== FOR USE BY EXECUTIVE COMMITTEE The above application was placed in the Executive Committee Meeting of the Forum held on………………… and the unit was admitted as member of the forum with effect from………………………….Resolution No………………………. Receipt No………………….. Stamp Secretary President