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PERSONAL INFORMATION
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Provisional Membership Type
Name (in block letters)
*
:
Primary Email :
Secondary Email
Counselee Code :
Nationality
:
Indian
Non Indian
Residential Address
Address
:
State
:
{name}
{name}
District
*
:
{name}
{name}
If you are not an Indian, Please enter the details :
Country
*
:
{name}
{name}
State
:
Pincode
:
Contact Information
Office
:
Residence
:
Mobile
:
Website :
Educational Qualification :
Date of Birth (DD.MM.YYYY)
*
:
Training in Business : Management/Experience (Mention Year, agency,etc.,)
Other Service Activities :
Awards / Recognitions any :
Are you a member of any other Organization ?:
Yes
No
ElseWhere
If Yes, specify :
Any other Relevant Information :
Father's / Husband's Name :
Profession :
BUSINESS INFORMATION
Name of the Business :
Business Address
Address :
District :
State :
Pin Code :
Contact Information
Telephone :
Fax :
Email :
Constitution : (Select Appropriate Options)
Proprietary
Partnership
Pvt Limited
Pub Limited
Others
None
Year of Establishment :
Position :
Proprietor
Managing Partner
Managing Director
Others
Have you registered under any of these Acts :
VAT
CST
Shops And Establishments
Are you an Income Tax Payee :
Yes
No
If Yes, specify PAN No. :
Type of Business :
Manufacturing
Trading
Service
Manufacturing And Trading
Manufacturing And Service
Manf And Trading And Service
Trading And Service
Sector :
Agriculture Based Products
Building Construction Products
Chemicals & Agarbathi Products
Electronics Products
Engineering Products
Food Products
Furniture & Interiors Products
Garments Products
Handicrafts Products
Healthcare Products
Jewellary Products
Leather Products
Painting Prodcuts
Service Products
Consumer Products
Others
None
NGO
Product Details :
Are you in Exports :
Yes
No
Export Turnover :
Since When :
Bankers :
Have you availed loan from Bank or any other Financial Institutions :
Yes
No
If yes, How much ?
Capital Investment in Business (in Rs) :
Total Turnover (in Rs) :
Number of People Employed :
Any other information (Business) :
Enclose photograph of member :
(Image should be in JPG,JPEG,GIF,PNG format with size not exceeding 1 MB)
Address to which the communication should be sent :
Residence
Office
Source of Business Idea :
Source of Technology :
Own
Bought
