Name of Organisation (in BLOCK letters)Name of Signatory (in BLOCK letters)Designation Proposed By Member's Name Seconded By Member's Name Information Regarding Applicant Applicant's Office Applicant' s Office Tel/Mob/WhatsApp Applicant's Office Website Applicant's Office EMail ID Applicant's Factory/Works Applicant's Factory/Works Tel/Mob/WhatsApp Applicant' s Factory/Works EMailID Constitution Registered Company Partnership Firm LLP Propietorship Indivisual AOP Registered Co-operative Society Financial Institution Foreign Business Concern other (Please furnish copy of RCC Certificate/ Partnership Deed/ other document as applicable) Industry/ Manufacturing sector Large Medium Small Micro Other Enterprise & Service Sector Registration & Other Details (Fill as Applicable) Registration under Factory Act I.E.M./ EM II/ Udyog Aadhar Service Tax Registration/ VAT/ CST/ GSTN Central Excise or any other Registration (if any) (Please furnish authenticated copy of the Registration paper)Year of establishment Number of persons employed Items being manufactured/ service being offered (Nature of Activities) Capital Ouy Lay (Value of plant & Machinery at cost) Gross Turn Over (Last F.Y.) In case of Applicants for Affiliated Membership only, the following documents are to be appended (in duplicate) (i) Constitution (ii) List of Members (iii) Primary/ focal area of activitiesIn case of Applications for individual Membership only Management Consultant Industrial Consultant Accountancy Practitioner Cost Audit Practitioner Legal Practitioner Names and designation of Representatives in order of preference Representative 1 Name Mob. No. Email Representative1 Photo Please upload image in JPG, PNG or GIF Format only. Representative 2 Name Mob. No. Email Representative 3 Name Mob. No. Email Member of any other Business Association/ Organisation Amount of remittance enclosed Total Rs Admission Fee: Annual Subscription: S. Tax/ G.S.T. By Cash Cheque D.D. N.E.F.T. No Cheque/ DD/ NEFT No Name of Bank Branch Enter Code Notes:- · Admission Fee & Subscription fee to be paid as applicable · Cheque/ Draft favoring BIHAR INDUSTRIES ASSOCIATION payable at Patna · NEFT/ NET-Banking Payment details- BIHAR INDUSTRIES ASSOCIATION, Account No. 10038443366 State Bank of India, B.S. Exam. Board Branch, IFSC Code No. SBIN0001215 · Please attach copies of documentary evidence for constitution details, registration with appropriate authorities, as applicable · Executive Council is sole authority to accept or reject any application Powered by ChronoForms - ChronoEngine.com
