Membership Application Form Renewal New

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ISO 9001: 2000

Infomediary Services Membership Application Form Renewal New

Document Ref: F: ITEC:01 Edition No.: 02 Page No.: 01 of 01 Place of Use: HO /ZO /RO /BO /SO /NTSC / NTSEC..

Issue Date: Issue Control Authority: Head, Infomediary Services, H.O. 1. Name of Company* (Write in Block Letters) M/s 2. Name of CEO/MD Mr. / Ms. / Mrs. 3. Address*

PIN E-mail* Website: Mobile No 0 4. Whether SSI:(Pl.Tick) 5. Activities: (Pl.tick) 6. Main Customers (Optional): 8. 9. 10. 11. 12. 13. Year of Establishment: ________________ Certification (if any) e.g. ISO, QS, BIS. Etc. Are you an Exporter (Pl.tick) Yes No Since (year) Tel. No Fax. No. Yes Manufacturer 7 Product(s)/Services*: Employment: __________ If Yes, Countries exported to: Product/Services exported: No Trading Services

Turnover in Rs.

Give a brief background and details of your company (Attach separate sheet if necessary): Are you looking for any kind of co -operations 14. as given below? (Pl. tick only) Offering Technology Looking for Technology Looking for Co-production Opportunity Distributorship 15. Looking for Sub-contracting Opportunities Product Selling Product Buying Demand Draft Details: (a) Name of Bank. (c) Amount: (d) Dated: Signature with Companys Seal & Date of Application for Info. Services Countries where you have current potential business interest

Attach up to five images of your products/services (Optional)

16. 17.

(b) DD. No. (e) Date of Application:

Fields marked with *(star) are compulsory. The National Small Industries Corporation Ltd. NSIC Bhawan, Okhla Industrial Estate, New Delhi-110020 Ph: 91 -11-26926275, 26927502, 1800111955(Toll free no), Fax: 91-11-26927160, Website: http://www.nsic.co.in, E-mail: info@nsic.co.in PLEASE DOWNLOAD APPLICATION FORM FROM THE LINK BELOW http://www.nsic.co.in/working/infoMemberForm.doc or .pdf

(Paste/staple your business card in this space)

-- -- - -- - -- - -- -- -- -- - -- -- -- - -- -- -- -- - -- -- -- - -- -- -- -- - -- -- -- - -- -- -- -- - -- -- -- - -- -- -- -- - -- -- -- The National Small Industries Corporation Ltd. NSIC Bhawan, Okhla Industrial Estate, New Delhi -110020 Ph: 91 -11-26926275, 26927502, 1800111955(Toll free no.) Fax: 91-11-26927160, Website:http://www.nsic.co.in, E-mail: info@nsic.co.in

Account No.(For office use only ) Company Name Name in full (Proprietor/Partner/Director) Validity (For office use only)

Affix Your Passport Size Photograph here

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