Appendix 19 A
Request For Registration Cum Membership Certificate
Date of Application 07 September 2010
Register us as
Name Of Applicant Firm
Website
Date Of Establishment DD/MM/YYYY
Address of Applicant (Reg.Office in case of Ltd. and Head Office for others)
Address State
City Pin Code
Branch Details
Name of Branch
Address of Branch State
City Pin Code
Factory Details
Name of Factory
Address of Factory State
City Pin Code
Address for Correspondence
Address State
City Pin Code
Contact Person
Mobile Office -
Fax -
Company Email
Alternate Email
Alternate Email
IEC Details
IEC Number *
Verify IEC No DGFT,(MOC, NEW DELHI) 		Issuing Authority *
Date Of Issue * DD/MM/YYYY
Upload IEC Document
 
*After Browsing please Click on Upload Button
PAN Card Details
PAN Card Number *
Upload PAN Document
 
*After Browsing please Click on Upload Button
Constitution *
If the registration is required as a Manufacturer exporter, SSI Registration/Industrial License /IEM / Other (specify)
Number Issuing Authority
Date Of Issue DD/MM/YYYY Expiry Date DD/MM/YYYY
Manufacturer Certificate
 
*After Browsing please Click on Upload Button
EH/TH/STH/SSTH/SHE/ISHE/ISSEH Certificate No. Valid Upto DD/MM/YYYY
Details of Directors/Partners/Proprietor/Karta/Parceners
Type
Name
Father's Name
Residential Address State
City Pin Code
Telephone Number -
Name of Export Product(s) or its category for which registration is required


Main Line of Business of Applicant
(eg. Apparel Textile / Cotton Textile / Man Made Textiles / Other Textiles)
Registration With any Other EPC's
Scanned Documents (accepted only .gif, .jpg, .tif or .pdf)
Payment Details
Cheque/DD should be drawn in favour of 'The Cotton Textiles Export Promotion Council'
Payment Type Amount 6000 INR
 Number  Date DD/MM/YYYY
Bank Name Payment Branch
  1. I/We here by solemnly declare that the above stated information Is true and correct. I/We undertake, without any reservation, to :
    1. Abide by the terms of the registration certificate grant to us on all our exports
    2. Agree to abide by any code of conduct that may be prescribed:
    3. Agree to abide by export floor price condition that may be stipulated by the Registering Authority:
    4. Furnish without fail monthly returns of exports including Nil returns to the Registrering Authority by 15th day of the month following the quarter.
  2. I/We further understand that our registration is liable to be cancelled in the event of breach of any of the undertakings mentioned above.
  3. I /We solemnly declare that we have applied to the Export Promotion Council which pertains to our main line of business. In case I/we have applied to any Council,the application has been made within the purview of the provisions of para 2.63 of the handbook of procedures(Vol1)
  4. I/We agree to send self certified of all above uploaded documents along with Cheque/DD.
Name *
Designation *
Tele No. * -
FAX No -

    
 
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