Membership Application Form
of
Shellac Export Promotion Council

The Executive Director,
Shellac Export Promotion Council,
"Vanijya Bhavan"
International Trade Facilitation Centre,
1/1, Wood Street, 2nd Flr,
Kolkata - 700 016.

Sir,

Kindly enroll me/us as a Member of Shellac Export Promotion Council, Kolkata.

I/We have read the rules & regulations for the Membership of the Council and the Constitution and agree to abide by the same. I/We give below the particulars of the firm/company/association/individuals :

1. Name of the Firm/company/ association/individual :

2. Postal Address :

(A) Head Office :

(B) Factory, If any :

3. Year of Establishment :

4. Telephone No(s). :

5. Fax No(s). :

6. E-mail No. :

7. Financial year for which Membershipis desired :

8. Whether an Individual, Firm, Joint Stock, Private Limited Company, Partnership concern or Association of persons. :

9. Name & Addressof Proprietor(s) / Partner(s) / Director(s) / Member(s) of Association :

10. Capital invested including Value of Plant & machineries etc., (copy of last audited and/or certified by Chartered Accountants, Balance Sheet to be attached) :

11. If exporter, items exported :

12. If Manufacturers, items manufactured or manufacturing :

13. If Merchants, items dealing :

14. Actual Production (Value) during the last year. In case of new company, anticipated production during the current year. :

15. Actual exports (Value) during the last year. In case of new company anticipated export during the current year. :

16. What was the annual turnover during the last three years for items covered under this Council, duly certified by a Chartered Accountant. :

17. Name of the products exported or to be exported :

18. Category of Membership desired Exporter/Merchant Exporter/Manufacturer/Manufacturer- Exporter/Dealer/Grower etc. :

(A) If Exporter

i) Importer Exporter Code No.
(Pl. attach self certified copy of the IEC No. issued by the Licensing Authority). :

(B) If Manufacturer, S.S.I. Registration No.
(Attach S.S.I. Certificate in original or one copy of Xerox) :

(C) If Manufacturer-Exporter, comply
(A) & (B) :

19. PAN Number (Pl. attach Self certified copy) :

20. Vat Registration No. (If applicable) :

21. Membership of Chamber of Commerce or other Association :

22. Name of Bankers : (A confidential report from Bankers in sealed cover is to be attached) :

23. Name & address of the representatives in order of priority who shall exercise the right and privileges of Membership. :

24. Any other relevant details supporting admission as Member. :


I/We hereby declare that the particulars given above are true and correct to the best of my/our knowledge and belief. I/We hereby agree to furnish other information also, if and when the Council requires.

                                   Signature of the Applicant :

                                   Designation :

                                   Office Seal :

                                   Name of the Firm/
                                   Company/Association. :


Place :
                                                                Address :
Date :

Enclosure :

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1. Annual Membership Subscription of the Council is Rs. 2,500/- only commencing from April to March each year. An amount of Rs. 20,000/- as Entrance Fee is to be paid once only. Payment by Cheque/Draft in favour of "Shellac Export Promotion Council"