Essential Oil Association of India
Regd. Office: L6/L7, 24, Veer Savarkar Block, Shakarpur, Delhi-110092
Admin. Office: C-56A/25, Sector-62, Noida-201301 (U.P.)
Ph. 0120-2400200 / 2400103
E-mail:
APPLICATION FORM FOR :
INDIVIDUAL LIFE/CORPORATE LIFE/ ASSOCIATE MEMBER
Instruction for filling the Application form:
a) Please write or type all particulars in BLOCK LETTERS.
b) In case of establishment, photocopies of certificate mentioned at S. No. 6 & 7 should invariably be attached alongwith the Membership Form.
c) Application should be accompanied by Demand Draft, payable at Delhi in cases of application submitted from outside Delhi.
d) Incomplete application will be rejected.
Class of Membership : INDIVIDUAL LIFE /CORPORATE LIFE / ASSOCIATE MEMBER
- Name of Applicant : ______
(In case of individual only)
- Name of the Co./Firm/Inst./ : ______
Assoc.
- Permanent Address : ______
______
______
Tel. (O) ______Fax______
E-mail ______
- Correspondence Address ______
______
______
Tel. (O) ______Fax ______
E-mail ______
5. Date of Establishment : ______
6. SSI Regn. No./Other : ______
Regn. Nos.
7. Sales Tax Regn. No./ : ______
P.A. No.
8. Particulars of the Directors/Partners/Authorised Persons
(In case of Corporate only)
1. Name : ______
Status : ______
Address : ______
______
______
Ph. (O)______(R) ______
Mobile ______Fax ______
E-mail ______
2. Name : ______
Status : ______
Address : ______
______
______
Ph. (O) ______(R) ______
Mobile ______Fax ______
E-mail______
3. Name : ______
Status : ______
Address : ______
______
______
Ph. (O) ______(R) ______
Mobile ______Fax ______
E-mail______
9. Nature of Activity (Please tick appropriate activity)
Manufacturers Consultant Producers
Cultivators Dealers Plant Breeder
Research Distillers Other (Pls. specify)
Recommendations
a) Proposed by EOAI Member : Signature ______
: Name & Address ______
______
______
______
M. No. ______
b) Seconded by EOAI Member : Signature______
: Name & Address______
______
______
______
M. No. ______
I hereby declare that the above information is correct to the best of my/Our knowledge and belief and that I/We have read the rules and regulations of the Association and undertake to abide by them.
Demand Draft No. ______dated ______for Rs. ______
(Rupees) ______
Drawn on ______(Bank) in favour of
“Essential Oil Association of India” payable at Delhi towards membership fee is enclosed herewith.
Signature ______
Name ______
Designation ______
Place :
Date : Company Seal
FOR OFFICE USE ONLY
RECOMMENDATION OF ZONAL VICE PRESIDENT :
Remark ______
Name: ______
Zone: ______
Date: ______
Received on ______Diary No. ______Approved by the Executive
Committee on ______
Gen. Secretary President
Admitted as Member on______as ______
Membership No. Allotted
Subscription Schedule
Class of Membership / Admission Fee(Rs.) / Subscription Fee (Rs.) / Total Fee (Rs.)
1. Life Member
(a) Individual/Life Member
(b) Corporate Life Member / 5000.00
5000.00 / 20000.00
40000.00 / 25000.00
45000.00
2. Corporate Member / 2000.00 / 3000.00 / 5000.00
3. Associate Member / 2000.00 / 4000.00 / 6000.00
*Note: Existing individual Life Members & Existing Corporate Fellow Members willing to convert their membership into Corporate Life Membership will be required to pay Rs.20000/- & Rs.40000/- respectively.