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APPLICATION FORM FOR MEMBERSHIP
iDkkI ma> jeaDava ma3e nu> FaemR The Secretary, Dalit Indian Chamber of Commerce and Industry 111, Block – B , Parmar Chambers, Sadhu Vaswani Chowk , Pune 411001 I hereby apply for membership of DICCI as Affiliated / Institutional Member. Company Information ( k>pnInI mahItI )
Name of the company/ Organization (2>2an>u nam)
Name of the Owner : (CMD/CEO/Director)
Naam t4a hodo Category :
)atI nI ivgt
Legal Status :
É
Ê
Ë
SC ST NT V J‐ NT AnusucIt JatI
AnusucIt jnJatI
2>2ano p/kar
Public Ltd Pvt.Ltd. Partnership Proprietary Type of Industry :
Large
lajR
2>2a nI sa{z
Medium MIDIym
Office Address :
Aofos
n>u srnam>u
Works Address :
fek3ro n>u srnam>u
Contact Details : s>pkRnI ivgt
Mobile No maeba{l n>br
Phone No
Faen n>br
E – Mail
{ - mee{l
Website
veb sa{3
Year Of Foundation :
2>2a n>u x½ kyaR n>u v8R
No.of Employee : K>pnI Maa> KamdarnI s>Qya
Page 1 of 2 Small Tiny Smol
Maa{K/o Type of Company : (Nature of Business)
2>2ano p/kar
Manufacturing Textiles IT & ITES Trading Service Leather Agro & Food Import – Export Plastics Construction Other Product / Service Details :
]Tpaidt Aa{3mnI A4va
sivRs nI ivgt
Present Customers: (Prestigious Clients)
Hal keva p/karnI k>pnIm>a mal
veco 0ae? Ke sivRs Aapo 0ae?
Probable Costumers : (ONGC, Rly,Tata etc.) AapnI p/aeDks/ sivRs
Kya ifLD ma> calI xke
Annual Turnover
vai8Rk 3nRAovr
Up to 25 Lachs 25 Lakhs to 3 Caror Above 3 caror ÊÍ laq 4o Ao0u>
ÊÍ laq 4o Ë kroD
Ë kroD 4o v2u
Additional Information ( If any) ivxe8 ivgt:
Enclosed Documents : nIce muJb DokyumeN3 nI kopI kUrIyr / po*3 ke [mel 4I moklI Aapo
1 DD/ Cheque No. : In Favour of DICCI, Pune Payable at Pune for Rs.5,000.00, Date: Bank :
½a.ÍÒÒÒ nae beNk no /Šaf3///cek DICCI, Pune na> name nIce muJb na srname moklI Aapo
2 MSME (SSI) Registration Certificate (EM‐Part 2)
Aem.Aes.Aem.[. rjIS3/exn ([.Aem.pa3R–Ê) s3oRFIke3 [ jo 2ravta hoy to.]
3 SC/ST Caste Certificate:
)ait n>u s3oRFIke3
4 Your Product /Sercvice Profile , if available :
AapnI k>pnI n>u lI3recr jo haey tae
5 Visiting Card & your passport photograph – 2 Nos. Aapn>u ivzI3I>g KaDR t4a paspo3R sa[zna be fo3a [ [mel krI xko 0o]
Name (Naam) :
Signature(sho) (With company Stamp) (k>pnIno sIKKae)
Please send this form to flowing Address: Aa foRm t4a DI.DI. nIcena srname moklo:
DICCI-Gujarat
C/o DINT-TECH CONTROL PVT. LTD.,
C2/1, Phase 2, Modern Bakery Road, Opp. Dressure-Rand, G.I.D.C., Naroda, Ahmedabad–382330
Mob.: 0942670 2671 | E: [email protected] |
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