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APPLICATION FORM
APPLICATION
ASSOCIATE MEMBERSHIP
ASSOCIATE
Federation of Indian
Chambers of Commerce & Industry
APPLICATION FORM FOR ASSOCIATE MEMBERSHIP
The Secretary Date: ____________
Federation of Indian Chambers of Commerce & Industry
Federation House, 1, Tansen Marg,
New Delhi - 110 001
Dear Sir,
We have the pleasure of applying for the Associate Membership of FICCI and request you to place our
application before the Executive Committee of the Federation at the earliest and look forward to receiving
your acceptance of the same.
Name of Company ___________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________________
______________________________________________________________ Pin: _________________
Tel: ______________________ Fax: _________________ e-mail: ____________________________
Address in Delhi (if any)
___________________________________________________________________________________
____________________________________________________________________ Pin: ____________
Tel: __________________________ Fax: __________________ e-mail: _______________________
Our Chief Executive: _________________________________________________________________
Designation: ________________________________________________________________________
Address ____________________________________________________________________________
____________________________________________________________ Pin ___________________
Tel. (off) (Dir.) __________ (Mobile) _______________ Fax __________ e-mail _______________
We are engaged in Trading/Manufacturing/Construction/Hotel/Information Technology/Investment/
Leasing/Hirepurchase/Banking/Merchant Banking/Portfolio management/NBFCs/Finance/Insurance/
Marketing/Brokering/Safe deposit/Travel Agency/Transport/Printing and Publishing/Cold storage/
Research/Consultancy/Management/Training/Auditing/Legal firm/Institutional/Commission agency/
Agency business.
Main Line: __________________________________________________________________________
of
business ___________________________________________________________________________
Our latest Turnover in The Year ______________________________ Rs. ___________________
We are a Manufacturer/ Marchant exporter and have the status of an Export House/ Trading House/
Star Trading House/ Super Star Trading House/ E.O.U./ E.P.Z.
Export turnover: $ _____________________________________ Year __________________________
Major Export markets ________________________________________________________________
No. of Employees (approx.) __________________________ Year of establishment _______________
Location of major factories: ____________________________________________________________
We nominate Mr/Ms __________________________________ Designation ___________________
as our representative in FICCI. All communication to him/her may kindly be sent at:
Address __________________________________________________________________________
_______________________________________________________ Pin _____________________
Tel. (off) __________ (Mobile) ___________ Fax ______________ e-mail ____________________
Name of Personal Secretary _____________________________________ Tel _________________
We agree to abide by the Memorandum and Articles of Association and the Rules of the Federation
We are sending herewith a cheque on a Delhi bank or a draft payable at Delhi bearing no.
Dt. ______________ for Rs. ________________ being the annual subscription (as per enclosed tariff)
alongwith a one time admission fee as applicable
Yours truly,
___________________ __________________________ __________________________
Date Name and Designation Signature of the applicant
Existing Membership of Chamber/ any Association (This information is vital).
We are a member of _______________________________________________________________
Sponsorship *:
We hereby certify that the applicant is a member of this Chamber/ Association. We have pleasure in
sponsoring this application for Associate membership of the Federation.
___________________ __________________________ __________________________
Date Name of Chamber/ Association Name and Signature
*If possible for you, please have your application sponsored.
Please attach the latest available Balance Sheet/Profit and Loss account, Corporate Brochure
or Company Profile.
Please refer to the enclosed subscription tariff for the annual subscription amount applicable to you.
Apart from the annual subscription amount, please also send a one-time admission fee as applicable
without which the application cannot be processed. All payments should be made by a cheque on a
Delhi bank favouring FICCI or by a draft payable at Delhi.
Please send the duly filled application form to Mr . S Ratnam, Consultant, Tel.: 2335 7368 (D) or
Ms. Parminder Juneja, Dy. Director, Tel.: 2348 7360 (D) You may also contact them for all membership matters.
Ph : 2373 8760-70 (11 lines) Fax : 2332 0714/ 23721504 E-mail: membership@ficci.com
(For office use only)
I have pleasure in sponsoring this application for Associate Membership of the Federation.
___________________ ___________________ ______________________
Date Name Signature
(To be made by an Executive Committee Member/Past President of FICCI)
This application was put up to the Membership Screening/ Executive Committee meeting held on
_________________ In ___________________ and formally accepted for admission / rejected.
This member East West North South
belongs to zone
___________________ ___________________ ______________________
Date Name Signature of FICCI official
FICCI OFFICES
INDIA
Mr Akhilesh Mahurkar Mr P Murari Mr Gyan Prakash
Director Advisor - President, FICCI Director
FICCI Andhra Pradesh State Council FICCI Rajasthan State Council
Mr S. Saravanan
8-2-699/1, 3rd Floor 202 Rajputana Tower
Deputy Director
K R Towers, Road No. 12 A-27-B, Shanti Path, Tilak Nagar
FICCI Tamil Nadu State Council
Banjara Hills Jaipur - 302 004
2A, Bajaj Manor, 14A, College Road
Hyderabad 500 034 Phone: 0141 5116464
Chennai 600006
Phone: 040- 23395275-76 Fax: 0141 5116464
Phone: 044- 42326329 (D) 42326331, 42327333,
Fax: 040- 23395275-76 Email: gyan@ficci.com
42326330 (Off)
Email: akhilesh.mahurkar@ficci.com
Fax: 044-42326263
Ms Mousumi Ghose
Email: saravanan.s@ficci.com
Mr Param J Shah Director
Head FICCI Eastern Regional Council
Mr Vijay Bhushan
FICCI Gujarat State Council 4, Camac Street 2nd Floor, Wing 'B'
Coordinator
A-311, Safal Pegasus, 100 ft Road, Kolkata 700 016
FICCI Chhattisgarh State Council
Prahladnagar, Ahmedabad - 380 015 Phone: 91-033-32940580, 40035347
JSPL Campus
Telefax: 079-26937581, 26937582, 26937583 Fax: 91-033 40035348
Mandir Hasaud, Chhattisgarh
Email: gujarat@ficci.com, param@ficci.com Email: ficci@ficcierc.com,
Raipur - 492 001
mousumi.ghose@ficci.com
Phone: 0771-2471400(D), 2471205-07
Dr. Vaijayanti Pandit
Fax: 0771-2471214/2471404
Director
Email: bhushan@ficci.com
FICCI Western Regional Council
Krishnamai Cooperative Housing Society Ltd
Ms. Priya Bhattacharjee
Ground Floor, Plot No. 33-B
Senior Assistant Director
Pochkhanwala Road, Worli
FICCI Karnataka State Council
Mumbai - 400 025
VITC Building, 1st Floor, Kasturba Road
Phone: 022-24966633-39 (O), 24968000
Bangalore - 560 001
Fax: 022-24966631-32
Phone: 080 22861949
Email: drvpandit@ficci.com, wrc@ficci.com
Email: priya@ficci.com
OVERSEAS
Ms. Ranjana Khanna Mr. Roney Simon Mr George Abraham
Assistant Secretary General Director- FICCI, Italy Chairman & Managing Director
FICCI - USA FICCI - Italy FICCI - Singapore
1050, 17th Street, NW Suite 600 Via Michele Diverio,1 The G A Group Pte Ltd
Washington DC 20036, USA Piazza Cavour-10023 No.1, Shenton Way #11-06
Tel.: 001-202-776-7181 Chieri- Turin, Italy Singapore 68803
Fax: 001-202-331-8703 Tel.: 00-39-3485-601208 Tel.: 00-65-64231078
Email: ranjana@ficci.com 00-39-3346-457431 Mobile: 00-65-96209720 (India 9741017927)
Email: rsimon@ficci.com Fax: 00-65-64231079
Mr. Atul Dalakoti Email: george@gagrp.com
Executive Director Ms Ridhika Batra
FICCI Office in China Director TAN SRI DATO' Ajit Singh
C 362 Jia Hao International Centre FICCI - UK Principal Advisor
116 Zizhu Yuan Road Room No. 415, 211- Piccadilly, FICCI for ASEAN
Hai Dian District London WIJ 9HF Nam Fatt Corporation Berhad
Beijing-100097 China Tel.: 020-7917 6810 40 Persiaran Sultan Ibrahim
Email: dalakoti@public3.bta.net.cn / Email: ridhika.batra@ficci.com 41300 Klang
dalakoti@gmail.com) Selangor, Malaysia
Tel: 00603 3341 4122
Cell: 00 6012 3081133
Fax: 00 603 3342 1959
Email: tansriajit@gmail.com
Federation of Indian Chambers of Commerce & Industry
Federation House, Tansen Marg, New Delhi-110 001
Tel: 23738760-70 Fax: (91) 11-23320714 & 23721504
Website: http:/www.ficci.com E-mail: ficci@ficci.com
