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

  1. Name of Applicant : ______

(In case of individual only)

  1. Name of the Co./Firm/Inst./ : ______

Assoc.

  1. Permanent Address : ______

______

______

Tel. (O) ______Fax______

E-mail ______

  1. 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.