The Regional Director

Confederation of Indian Industry

(Northern Region)
Block No 3, Dakshin Marg
Sector 31-A
Chandigarh - 160 047
The Regional Director
Confederation of Indian Industry
(Eastern Region)
6, Netaji Subhash Road
Kolkata - 700 001
The Regional Director
Confederation of Indian Industry
(Southern Region)
Prof C K Prahalad Centre
98/1, Velachery Main Road
Guindy, Chennai - 600032
The Regional Director
Confederation of Indian Industry
(Western Region)
105, Kakad Chambers
1st floor, 132, Dr Annie Besant Road
Worli, Mumbai - 400 018
(Please tick on the basis of location of your primary establishment)
Dear Sir,
We wish to apply for CII Membership. The Application Form, duly completed, is submitted along with the relevant supporting
documents.
Kindly acknowledge receipt of the above and confirm our Membership.
Yours faithfully,
(Signature) Date
Name
Designation
Organisation
Address
N.B. : This application should be proposed and seconded by two existing CII members (Authorised Signatory with Company stamp).
0
2
Proposed by
0
1
Signature
Name
Designation
Company
City
Seconded by
Signature
Name
Designation
Company
City
APPLICATION FORM
member

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1. Name of the organisation / company :
2. Name and designation of Chief Executive :
3. Name and designation of principal representative :
Phone : Fax :
Email : Website :
4. Address :
5. Type (indicate) Manufacturing Service Foreign Multinational
6. Sector (indicate) Public Central Public State Public Limited Private
(Public means a State/Central Government undertaking) Joint Venture (% of foreign holdings)
(Please name the foreign partners)
7. Scale (indicate) Large Medium Small
8. Indicate the CII Division(s) you would like to join :
9. Company data
(a) Capital employed (Investment in plant & machinery) : Rs.
(b) Sales turnover (last two years) : Rs. in year
Rs. in year
10. Major Activities
(a) Manufacturer of :
(b) Agents of :
(c) Services rendered :
11. How do you expect to benefit from :
CII membership? (Attach separate sheet, if necessary)
12. Payment details (a) Entrance fee : Rs. (b) Membership fee : Rs.
Our cheque/DD No . dated for Rs. Drawn on favouring
Confederation of Indian Industry is enclosed.
Encl: 1. Latest Annual Report / Balance sheet / Audited Accouts 2. Company Profile
3. Certificate of Registration, if SSI 4. Note on your expections from CII
5. List of Key Management Personnel 6. DD / Cheque
RC Meeting Approval Date : __________________
MEMBER CODE ER NR SR WR
We hereby give our consent to abide by the Rules and Regulations of the Confederation.
Signature Name
Date Designation
FOR CII OFFICE USE ONLY
APPLICATION FORM
member
(If you have other offices in India/abroad,
please attach their complete addresses)

for liaison with CII

(Please fill in block letters)
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