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 :