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 :