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Membership Form
Member
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New Member
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Details of Industry
Name
Tele No
Address
Mobile
Email
Website
Head / Regd.Office Address
Same as above:
Address
Phone No
Fax No
E-Mail
Web Address
Representatives
Name
Designation
Mobile
Photo(to be pasted)
Scale(Please tick mark):
Small Scale
Medium Scale
Large Scale
Type(Please tick mark):
Chemical
Textile
Paper
Engg/Elec.
Plastic/Rubber
Others
Category(Please tick mark):
Agro
Dyes
Dyes Intermediates
Pigments
Paints
Pharma
fee paid by cheque/DDNo
Date
Amount
Bank
Water Connection No:
Drainage Connection No
DGVCL Consumer No
Feeder No
HT/LT
Product
Raw Material
Signature of Proprietor / Authorised Partner / Director / Manager of the Company with Rubber Stamp
Proposed by Member Industry (Name & Address)
Seconded by Member Industry (Name & Address)
Signature with Rubber Stamp
Signature with Rubber Stamp
Please attach :
Copy of Possession Receipt or Final Transfer order of GIDC
Copy of Udhyog Adhar for MSME and DGTD/IEM Certificate & Factory Licence for large Industries
Copy of Motive Power Bill
Copy of Partnership deed in case of partnership firm or Memorandum & Articles in case of Pvt Ltd / Limited Company
Copy of notarized Sole power of Attorney in favour of the authorized representative duly signed by the proprietor and in case of Partnership firm signed all partners In case of Pvt Ltd / Limited Companies,Board Resolution and Authority Letter/Power of attorney dully signed by the chairmen/vice Chairmen/Managing Director/Director
One Stamp size photograph of each authorized representative in addition to the photograph pasted at the space provided
Copy of GST Registration
Copy of Registration Certificate of RoC in case of Pvt Ltd Companies
MEMBERSHIP FEE
Large Scale
Medium Scale
Small Scale
Admission Fee
Rs.50,000.00
Rs.25,000.00
Rs.10,000.00
Annual Membership Fee
Rs. 0.50 Per Sq.Mtr.Plot Area
Rs.0.50 Per Sq.Mtr.Plot Area
Rs.0.50 Per Sq.Mtr.Plot Area
Life Membership Fee
+GST 18% EXTRA
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