INDO-AUSTRALIAN CHAMBER OF COMMERCE

CORPORATE MEMBERSHIP FORM

     Name of the Organisation :_______________________________________________________________________________

     Address : _________________________________________________________________________________________________

                          __________________________________________________________________  PIN :  111111

     Telephone/s: ________________________________________                 Fax : ______________________________________

     E-mail : _______________________________________________     Website : ______________________________________

     Name of the MD / CEO : __________________________________________________   (Mobile : ________________ )

     Name & Designation of the official for communication :_________________________________________________

     Business Interests                  

           1 Exports                       1 Imports                     1 Investment              1 Joint Ventures

           1  Consultancy                    1 Education                       1 Tourism                         1 Others

     Description of Products / Services : _____________________________________________________________________

      __________________________________________________________________________________________________________

     Tie-ups in Australia, if any : ____________________________________________________________________________

                                                                                                                          (Signature of the Applicant with Designation)

     Place :

     Date :                                                                                                                       

                                                                                              ( Please affix Company's Official Seal)

     Encl : Cheque / DD No. __________ dated ____________ for Rs. 7,000/- (Admission Fee: Rs. 2,000  plus Annual Subscription: Rs. 5,000) drawn on___________________________________________.

   The Cheque / DD may be drawn in favour of Indo-Australian Chamber of Commerce, payable at Chennai.

______________________________________________________________________________________________________________

FOR OFFICE USE

     Receipt No. _______________  Dated______________  Admitted by the Council on ___________________