Directorate of Industries, Uttar Prudish G.T. Road, Kanpur208002 (India) Tel.: 00915122218401, 2216663, 2218830 fax: 00915122219288, 2216663, 2218830 Application Form For Membership (Valid up to Five Years) 1. Name of the Unit : .................................... \2. Address : ........................................ Tel.: .......... Telex: .........Fax: .......Cable: .......... 3. Name & Designation of Executive : ............................... 4. Status of the Unit(SSI/Medium/Large) : ............................ 5. Are you registered Exporter (Yes/No) : ............................. If yes please attach photocopy of registration certificate. 6. Are you registered as a Small Scale Industry. If yes please: ...................... attach photocopy of registration certificate 7. Products being manufactured/exported/imported from India : ................... 8. Major export market of the products : ............................ 9. Membership fee of U.P.T.P.A SSI unit Rs. 2000/-: ....................... Medium Industry RS. 10,000/-Heavy Industry Rs. 20,000/-Foreign buyers & their agents Rs. 20,000/Institutions/Associations/Chambers Rs. 20,000/- Note : Demand Draft as applicable above is to be paid in favors of U.P. Trade Promotion Authority, Kanpur along with this application. We hereby accept the rules & regulations of Membership of U.P.T.P.A. and enclose crossed Demand Draft of Rs. being the annual membership fee Signature of the authorized Signatory of the Company Date: Name ........... Designation .......... Created by trial version, http://www.8848soft.com
