APPLICATION FORM

I Shri   ____________________________________________________________________

Director/Partner/Proprietor of M/s._____________________________________________ request you to enroll our/my firm as member of the Association.  We/ I, are/am the authorized Cement Stockiest of___________________________________________. We/ I will abide by the rule and Regulation of the Associations.

Firms Name   :  ____________________________________________________

Address: ________________________________________________________________

______________________________________________________________________

 Phone No.  ------------------------ Fax No. ------------------------- Mobile No.  ----------------

E- Mail ID:- __________________________

Partners   :   ---------------------------------------- Address  : ---------------------------------------

Recommended by    :______________

For Office use

Rs. -------------------   is paid by Cash/Cheque No.---------------------- on ----------------

For Year ------------------------------. Approved / Rejected        Reason_______________

Treasurer /President/ Secretary

Pune Cement Dealers' Association

• Member Ship Fees :   Enters fees  Rs.500 +2000 (Yearly fees)= Rs.2s,500/-