MADIGA INDUSTRIAL CHAMBER OF COMMERCE AND INDUSTRY
APPLICATION FORM FOR MEMBERSHIP
(
*
) Indicates a Required Fields.
Chapter
Place
*
Company
Organisation
Name of the Compnay / Organisation
*
Mr.
Mis.
Mrs.
Full Name
*
Office Address
*
Work Address
*
Phone No.
*
Mobile No.
*
Email
*
Website
Nature of Business
*
Manufacturing.
Services
IT & ITES
Import - Export
Trading
Any other Specify...
Leagal Status
*
Public Ltd.
Pvt Ltd.
OPC
LLP
Partnership Firm
Proprietary
Type of Industry
*
Large
Medium
Small
Micro
Incorporation Date
*
No. of Employees
*
Product Details
Last 2Years Turnover
Direct & Indirect Taxes Paid
Date of Birth
*
Caste Category
*
SC
ST
PAN No.
*
Udyog Aadhar No.
GST Reg. No.
Service Tax Reg. No.
ESI Reg. No.
PF No.
IE Code No.
Certification If Any
Existing Clients
Raw Material Required
Probable Customers
Additional Info (If Any)
Passport Photo (Latest)
*
Caste Certificate (Any Other Documents)
*
Register