MEMBERSHIP NO.

PHOTO

INDIAN MOTION PICTURE

PRODUCERS’ ASSOCIATION
G-1 to 5, Crescent Tower, Near Morya House, Opp. VIP Plaza, Link Road, Andheri (West), Mumbai 400 053.
Tel. (Andheri): 77150 72777 / 88790 31147 / 2673 2868 / 26742892
Regd. Address: “IMPPA House”, Dr. Ambedkar Road, Bandra (West), Mumbai - 400 050.
Tel (Bandra): 2648 6344 / 45 / 2648 1760  Fax: 2648 0757
E-mail: imppa1937@gmail.com

APPLICATION FOR MEMBERSHIP

The Secretary,
Indian Motion Picture Producers’ Association, Date: - 20
IMPPA House, Dr. Ambedkar Road,
Bandra (W), Mumbai-400 050.

Dear Sir,

I/We hereby apply for the membership of the INDIAN MOTION PICTURE PRODUCERS’
ASSOCIATION and give hereunder particulars of my / our concern for your consideration.

(1) Name of applicant’s Firm / Company :

(2) Date of formation / incorporation :

(3) Full Address and Telephone & Fax No. :

and E-mail of Firm / Company

(4) Whether Proprietory Concern/Partnership :

Firm /Limited Company (Attach photocopy of
Partnership Deed/copy of Memorandum & Article
of Asso. & certificate of incorporation of the Co.)

(5) (a) Name and Residential Address of the :

Proprietor / Partners / Directors

(b) Telephone / Fax / Mobile No. :

c) E-mail :
(6) Details of Films/TV Serial/Telefilms/Doc. :
Short Film/Albums/Event/Ad Films
Produced if any in the past
(enclose copy of Censor Certificates) or
proof of Production and Telecast of Serial

(7) Name & Address of Authorised :

Representative (authorised Representative
has to be either the Proprietor or any of the
Partners / Directors of the Company)

(8) Date of Birth of the authorised representative :

I / We have read the Memorandum and Articles of the Association and agree to abide by all the rules and regulations
made there under in all respects on admission. I am a member of other Producers Association i.e.
There is no claim pending against us in the other Association.

Signature
 N.B.:(i) Mere acceptance of the application form / Admission Fee / Annual Subscription shall not constitute
the admission or acceptance of the application. Membership shall be granted only after applicant’s
name / banner has been duly approved by the Membership Scrutiny Committee of IMPPA.

(ii) Please enclose four postal stamp size photographs to the application for Identity Card.

(iii) For the address / Identity proof, enclose Xerox copy of Ration Card or Electricity or Telephone Bill or
Passport or PAN Card etc along with proof of Bank account in name of firm / Company.
(Proof of bank account can be submitted within 6 months or before 31 st March whichever is earlier
otherwise membership will not be renewed for further period.)

(iv) For outstation cheques Rs. 100/- extra towards Bank Charges are to be paid.

(v) Only One Identity Card will be issued by IMPPA free of cost to the members of IMPPA i.e. in favour
of the Proprietor / Proprietress in case of Proprietorship concern, one Partner in case of partnership
Firm and one Director in case of Ltd. Co. and / or Pvt. Ltd. Company. A copy of the solution from the
firm / company is required alongwith current list of members of the firm / directors of the company.

(vi) In case any member wants to have Additional Identity Card on behalf of their Firm / Company in
favour of other Partner/s and /or another Director/s, the IMPPA will issue the said Additional Non
Voting Card/s against Payment of (Rs. 2000/- + Service Tax) Per Card being the additional fee
for such cards on request.

(vii) A sum of Rupees Five Thousand (Rs. 5000/- + Service Tax) will be paid by overseas parties
towards Postage Charges.

(viii) Life Membership shall be granted only to persons who have produced and censored minimum
one Film (not dub) or telecast 13 episodes of any serial.

(ix) If all formalities and submission of Proof with any application form are not done within 15 days the
Fees deposited will be not refund.

Details of payment to be made

* Admission Fee - Rs. 4,000/-

* Annual Subscription for all Classes of Members - Rs. 1,000/-

* Service Tax @ 14.5 % - Rs. 725/- Rs. 5,725/-

Cheque / Draft as Donation in favour of - Rs. 5, 000/-
IMPPA Welfare Trust

Life Membership Fees

* a) Life Membership fee for New Applicants - Rs. 30, 000/-

Service Tax @ 14.5 % - Rs. 4, 350/- Rs. 34, 350/-
IMPPA Welfare Trust (Donation) - Rs. 5, 000/-

* b) Existing Members Life Membership Fee - Rs. 30, 000/-

Service Tax @ 14.5 % - Rs. 4, 350/- Rs. 34, 350/-

The above fees & Service Tax are subject to change.

For Office use only

Decision of Membership Scrutiny Committee / Executive Committee

Admission on

INDIAN MOTION PICTURE PRODUCERS’ ASSOCIATION

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 IMPPA WELFARE TRUST
Dated:

The Managing Trustee

IMPPA WELFARE TRUST
G-1 to 7, Crescent Tower,
Nr. Morya House, Opp. VIP Plaza,
Link Road, Andheri (W),
Mumbai – 400 053.

Dear Sir,

Sub: Donations to the Corpus of the Trust

Enclosed, please find herewith Cash/Cheque/DD No. dated

drawn on for Rs. 5,000/-

(Rupees Five Thousand only) as a donation to the Corpus of the Trust.

Name :

Banner Name :

PAN No. :

Address :

Proprietor / Partner / Director