APPLICATION FORM

member
ü(Please tick on the basis of location of your primary establishment)
The Regional Director The Regional Director The Regional Director The Regional Director
Confederation of Indian Industry Confederation of Indian Industry Confederation of Indian Industry Confederation of Indian Industry
(Northern Region) (Eastern Region) (Southern Region) (Western Region)
Block No 3, Dakshin Marg 6, Netaji Subhash Road Prof C K Prahalad Centre 105, Kakad Chambers
Sector 31-A Kolkata - 700 001 98/1, Velachery Main Road 1st floor, 132, Dr Annie Besant Road
Chandigarh - 160 030 Guindy, Chennai - 600 032 Worli, Mumbai - 400 018

Dear Sir,
We wish to apply for CII Membership. The Application Form, duly completed, is submitted along with the relevant supporting
documents.
Kindly acknowledge receipt of the above and confirm our Membership.
Yours faithfully,

(Signature) Date Company Seal

Name
Designation
Organisation
Address

N.B. : This application should be proposed and seconded by two existing CII members (Authorised Signatory with Company stamp).

Confederation of Indian Industry

Proposed by
02 01

Signature

Name

Designation

Company

City

Seconded by

Signature

Name

Designation

Company

City
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