MEMBERSHIP FORM

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Registered & Head Office: 4, Upper Ground Floor, Samruddhi Venture Park, SEEPZ-MIDC Central Road, Andheri (E), Mumbai – 93. INDIA.

Tel: +91 – 22 – 6150 9800 / 6667 4444 |Fax: +91 – 22 – 2825 0414 | Email: | Website: www.startupscouncilofindia.com

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Name of the Organisation
Name of the Applicant / Designation:
Education Background
Work Experience, if any
Contact Details: Tel: Mobile No: E-mail:
Name of the Contact Person: / Designation
Contact Details: Tel: Mobile No: E-mail:
Website:
Name and Contact Details of the Other Directors / Partners (if any):
Business Activities:
Business / Industry Sector:
Details of Products Produced
Details of Services Provided by Company
Company Involved in :
5 Manufacturing 5 Service Industry 5 Infrastructure 5 FMCG 5 E-Commerce 5 Exports 5 Automobiles 5 Financial Services 5 ICT 5 IT 5 Education 5 Hospitality 5 Entertainment 5 Realty 5 Logistics 5 Tours & Travels 5 Business Consultancy 5 HR 5 Others ______
Company Registered as:
5 Private Limited 5 LLP 5 Partnership Firm 5 Public Limited 5 Proprietorship 5 Others ______
Date of Registration Company or Business :
Registered and Head Office Address : / Tel. 1. / Fax:
Website / E-mail:
Turnover of Company for last 3 years (in Rs. Lakh) / Previous Year 2 / Previous Year 1 / Last Year
Total Investment in Plant Machinery or Equipments:
(in Rs. Lakh)
Capital Investment
Funds obtained from
Number of Employees / Management / Skilled / Unskilled
Intention or Motive to Start Business activity
Are you enjoying any bank facility?
End users of products or services
Are you looking for support for business growth or expansion? (Regional and National Market)
Are you looking for bank finance or investment for business growth or expansion?
Are you interested for Joint Ventures / Advanced Technology / Technology Transfers / Contract Manufacturing tie ups with Indian or foreign companies?
(If manufacturing unit)
Are you looking Marketing, Branding or promotion support?
Are you looking business / channel partners / distributors? Provide details
Are you looking potential clients or customers? Explain
What kind of Advisory / Consultancy Services required from the Council?
Are you facing any business problems and issues with specific sectors?
Are You Interested to be an active member? (Regional Committee, Expert Committee, Study Group)
Recognition and awards, if any

MEMBERSHIP CATEGORIES & FEE

Sr. No / Membership
Category / Who Can Apply for Membership? / Annual Membership
(12 months) / Membership Advantages
A / Gold / Start-ups, young entrepreneurs
And all types of business activities and individual businessman / Rs. 7,500/-
+18% GST
/ §  Enrollment as the member
§  Subscription of Newsletters, Events info, business opportunity, Networking, Advisory services,
§  Event Discounts, Special Discount on various support services, advertisements, promotional activity
§  Connectivity with investors, FIIs,
§  Share business enquiries, Articles on knowledge and experience
B / Platinum / Entrepreneurs, Corporate,
Education, Institutions,
MNCs, Mid Corporate, SMEs, Logistics, Infrastructure,
Real Estate, Entertainment, Hospitality, Media or any business house / Rs.25,000/-
+18% GST
/ §  Enrollment as the member to connect with startups
§  To utilize platform for promotion and branding
§  Opportunity for sponsorship and knowledge sharing
§  Identification for potential startups as channel partners or distributors
§  Discounts on advertisements, promotional activity and other events
§  Mentoring sessions
§  Active participation
C / Diamond / Venture Capital,
Private Equity,
Financial Institutions,
HNIs, Investors or Individuals / Rs.50,000/-
+18% GST
/ §  Enrollment as the member to connect with startups
§  Leads for potential startups for investment
§  Subscription of Newsletters, Events info, business opportunity, Networking, Advisory services,
§  Event Discounts, Special Discount on various support services, advertisements, promotional activity
§  Share business enquiries, Articles for newsletter, report and blogs
§  Dedicated account manager for coordination

I am applying for Membership under the Category of ______of the Council and submitting herewith true and correct information about my Company and Business Activities. I / We agree to abide by the rules and regulations of the Council as amended from time to time.

The Membership Fee by Cheque / Demand Draft No.______Dated______for Rs.______/- Drawn on Bank ______Branch ______(favoring “SMALL & MEDIUM BUSINESS DEVELOPMENT CHAMBER OF INDIA”, Mumbai”).

Yours sincerely,

Applicant's Signature (with Company Seal) Name: ______Designation: ______Date: ______

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Important Notes / Terms & Conditions

§  Membership Fee by Cheque / D. D / Bank Transfer

§  Photocopy of Certificate of Company / Business Registration if any

§  Photograph of Applicant and career profile

§  Acceptance / refusal of membership will be at the sole discretion of the Managing Committee of the Council.

§  No refund will be given for cancellation of any type of Card for any reason whatsoever.

§  Incomplete Application Forms and those which do not fulfill the above requirements will not be accepted.

§  SMALL & MEDIUM BUSINESS DEVELOPMENT CHAMBER OF INDIA is the official associate organisation authorized for collection of fee or subscription or participation fee of each event on behalf of START-UPs COUNCIL OF INDIA. Chamber provides unique support for education and training for start-ups and young entrepreneur

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(For office use only) Card Approval
Card Category ______Card No. ______Date of Approval ______
Authorised Signatory______

July 2017