Name * Designation * Organisation * Address * N.B. : This application should be proposed and seconded by two existing CII members (Authorised Signatory with Company stamp). Proposed by 01 Signature Name * Designation * Company * City * Seconded by 02 Signature Name * Designation * Company * City * Application Form Member (All Fields are Mandatory) 1. Name of the organisation / company : 2. Name and designation of Chief Executive : 3. Name and designation of principal representative : Contact No. : Fax : Email : Website : 4. Address : 5. Type (indicate) : CompanyGroupNGOEducationalInstitution 6. Sector (indicate) : Public CentralPublic StatePublic LimitedPrivate 7. Major Activities (a) Manufacturer of : (b) Agents of : (c) Services rendered : 8. How do you expect to benefit from : WPDO membership? (Attach separate sheet, if necessary) Enclosure: 1.Registration certificate 2. List of Key Management 3. Company Profile We hereby give our consent to abide by the Rules and Regulations of the Confederation. Signature Attachment (Only jpg & png format supported. Maximum file size - 2 mb)         Name : Date :   Designation :