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Registered Address :



Billing Address:

 Same as above


Communication Address:



Additional Information :

Representative Name and Details:

Contact person Name and Details:

Contact Details :   (*Please mention Department wise key contacts of your organization)

Sr NoDepartmentFull NameEmailDesignationMobile NoTelephone
1
2
3
4
5

Contact Details :   (*Please mention Reference of two IMC or IMC Ladies Wing Members)

Sr NoFull NameEmailMobile No
1
2

Areas of Interest & Contribution (Kindly Mark the appropriate /suitable box)

Art, Culture & History
Current Affairs & Environment
Education & Learning
Health & Fitness
Training for Entrepreneurs & Professionals
NGO Projects & Social work
Industrial visits & study tours
Women & Child Empowerment

Required Documents :   (*Please Upload Self Attested .pdf file of documents and .jpeg or .png file of photograph)

Photograph of Representative  (.jpeg or .png file only)
Proof of address  (.pdf file only)
Latest Utility Bill (Electricity Bill/ Telephone Bill) or Latest Bank statement with Address or Aadhaar Card
GST registration certificate  (.pdf file only)
(If Applicable)
GST Registration Certificate  (.pdf file only)
(Only if Applicable)
Partnership Deed  (.pdf file only)
Shop and Establishment Certificate  (.pdf file only)
Udyog Aadhar  (.pdf file only)
Import Export Code Certificate  (.pdf file only)
Certificate of Registration under relevant Act or Trust Deed or MOA - AOA  (.pdf file only)
Student's identity card (.pdf file only)
Certificate of Incorporation  (.pdf file only)
Membership of relevant professional body  (.pdf file only)
Passport/ Aadhar Card  (.pdf file only)
Pan Card  (.pdf file only)
Latest Audited Balance Sheet  (.pdf file only)
Certificate of registration under Shops and Establishment Act./Partnership Deed  (.pdf file only)
Choose industry information*:   (*Industry Information is mandatory)
Industries List*:

Principal Business Details:
Manufacturing
Trading
Services
Payment Method :


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