1. Form submitted for
2. Membership Type
3. Registration Under Chapter
4. Name of Enterprise
5. Constitution
6. Share Holding
7.(a). Name of the Proprietor / Partner / Director / Promoter:
(b). Upload Photo
Only PDF, JPG or PNG file Upload
8. Enterprise promoted by:
Women
Divyang (Physically Challenged)
9. Caste/Tribe Name
10. Caste Certificate
Only PDF, JPG or PNG file Upload
11. Address:
(a). Registered Office
Country
State
City / Town / Tehsil
District
Postal Code
Landline (With STD Code)
Mobile
E-Mail
Business Website
(b).Factory/Plant:
Same As Registered Office
Country
State
City/Town/Tehsil
District
Postal Code
Landline (With STD Code)
Mobile
E-Mail
(c).Permanent :
Country
State
City / Town / Tehsil
District
Postal Code
Landline (With STD Code)
Mobile
E-Mail
12. Other Company Details:
PAN No:
GSTIN:
Udyam No:
ESI Regn.
CIN No.
PF Regn.
Proprietorship/ Partnership Registration No.
13. Date of Incorporation
14. Industry Activity:
Investment in Plant and Machinery
Petroleum Products:
Specify Activity:
15. Industry Category:
16. Total Number of Employees
17. National Industry Classification (NIC) Code for Activities

(If You select industry activity is trading then Point No. 15 not for you.)

NIC Activity
NIC 2 Digit Code
NIC 4 Digit Code
NIC 5 Digit Code
NIC 2 Digit Code.
NIC 4 Digit Code
NIC 5 Digit Code
Add More Activity

18. No. of SC/ST Employees
19. Turn Over
(In Lakhs)
20. Our Products:
21. Raw Materials reqd:
22. Our Major Clients:
23. Probable Clients:
24. Do you have any other firm/business/sister concerns?:
If yes, Name of the firm:
25. Have you adopted DICCI voluntary code of conduct?
26. Have you attended any

(Number of events attended in the last financial year)?:

27. Have you attended any trade fair / exhibition?
28. Have you availed any government subsidy? :
NSSH/NSIC
Central Government Scheme
State Government Scheme
Subsidy Scheme:
29. Introduced By
30.Mode of Payment

Only DD/NEFT in favour of “Dalit Indian Chamber of Commerce and Industry” payable at New Delhi

Bank Details :
Bank Name :

STATE BANK OF INDIA

A/C HOLDER :

DALIT INDIAN CHAMBER OF COMMERCE AND INDUSTRY

Account No :

38410650441

Account Type :

Current Account

IFSC :

SBIN0013913

Bank Address :

SME BRANCH SOUTH EXTN, NEW DELHI


I, on behalf of my enterprise, hereby declare that all the above information submitted by me is correct to the best of my knowledge and that I am aware of the terms and conditions of the membership for Dalit Indian Chamber of Commerce and Industry (DICCI). DICCI reserves the right of acceptance of the membership. If any of the above submitted details are found to be false/malicious, DICCI reserves the right to reject/discontinue the membership without any notice. I understand that the membership fee once paid shall not be refunded under any circumstances. I hereby agree to all terms and conditions of membership and give my consent to use the above mentioned data for organizational purposes and/or other statutory compliances as that may be deemed necessary by Central/State Governments.

DICCI Head Office

Dalit Indian Chamber of Commerce and Industry
Office No.111, Block - B, 1st Floor, Parmar
Chamber Bldg, Sadhu Vaswani Chowk,
Pune Station Area, Pune 411001.
Phone: 020-2606 8800,
Email: info@dicci.in
URL: https://dicci.in

DICCI Corporate Office

Dalit Indian Chamber of Commerce and Industry
E-4, 1st floor
South Extension I,
New Delhi, Delhi 110049
Phone : 011-24690014
Email: info@dicci.in
URL: https://dicci.in

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