DICCI MEMBERSHIP FORM

1. Form submitted for :

  • New Membership
  • Membership Renewal
  • Start-Up Member

2. Membership Type :

  • PLATINUM - LIFE TIME MEMBERSHIP - AMOUNT Rs. 1,00,000.00 (INC. OF GST)
  • GOLD - MEMBERSHIP FOR 15 YEARS - AMOUNT Rs. 50,000.00 (INC. OF GST)
  • SILVER - MEMBERSHIP FOR 10 YEARS - AMOUNT Rs. 25,000.00 (INC. OF GST)
  • REGULAR - MEMBERSHIP FOR 1 YEAR - AMOUNT Rs. 5,000.00 (INC. OF GST)
  • RENEWAL - MEMBERSHIP FOR 1 YEAR - AMOUNT Rs. 2,500.00 (INC. OF GST)
  • START-UP - MEMBERSHIP FOR 1 YEAR - AMOUNT Rs. 2,000.00 (INC. OF GST)

3. Registry Under Chapter :

  • North
  • South
  • East
  • West

4. Name of Enterprise :

5. Constitution :

  • Proprietorship
  • Partnership
  • Limited Liability Partnership
  • One Person Company
  • Private Limited Company
  • Public Limited Company

6. Share Holding

(only fill when constitution is Proprietorship, Partnership, Limited Liability Partnership, One Person Company, Private Limited Company, Public Limited Company) :

Choose % for SC shareholding...

Choose % for ST shareholding...

7. If Enterprise promoted by:

  • Women
  • Physically Handicapped

8. Name of the Proprietor / Partner / Director / Promoter:

9. Social Category:

  • SC
  • ST

Caste/Tribe :

10. Registered Office Address:

Country :

State :

City / Town / Tehsil :

District :

Postal Code :

Postal Code

Landline (With STD Code) :

Mobile :

E-Mail :

Business Website :

Factory/Plant Address:

  • Same As Registered Office

Country :

State :

City / Town / Tehsil :

District :

Postal Code :

Postal Code

Landline (With STD Code) :

Mobile :

E-Mail :

PAN No :

GSTIN :

Udyog Aadhar No:

ESI Regn. :

CIN No. :

PF Regn. :

11. Date of Incorporation:

Investment in Plant and Machinery(on tick on Manufacturing and Services)

Amount In Lacs

Specify Activity(on tick on Trading and others)

Petroleum Products(on tick on Trading)

13. Industry Category :

  • Micro - Up to Rs.25 Lakhs
  • Small - Rs.25 Lakhs to Rs.5 Crore
  • Medium - Rs.5 Crore to Rs.10 Crore
  • Large - Rs.10 Crore and above

14. Total No. of Employees :

14. Total No. of Employees :

15. National Industry Classification (NIC) Code for Activities :

NIC Activity

  • Manufacturing
  • Services

NIC 2 Digit Code :

NIC 4 Digit Code :

NIC 5 Digit Code :

16. No. of SC/ST Employees :

SC

ST

OBC

Women

Minorities

17. Turn Over :

Current Year

Last Year

18. Our Products :

19. Raw Materials reqd:

20. Our Clients:

21. Probable Clients:

22. Do you have any other firm/business/sister concerns:

  • Yes
  • No

If yes, Name of the firm :

23. Have you adopted voluntary code of conduct

  • I have adopted the DICCI Code of Conduct for Affirmative Action

24. Have you attended any

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

Entrepreneurship Development Program (EDP)

Vendor Development Program (VDP)

Buyer-Seller Meet

25. Have you attended any trade fair / exhibition:

Number Of Domestic Exhibition

Number Of International Exhibition

26. Have you availed any government subsidy :

  • NSSH/NSIC
  • Central Government Scheme
  • State Government Scheme

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
PAN Number: AAECD8556F
IFSC : SBIN0013913 Address : SME BRANCH SOUTH EXTN DELHI, A-5, RING ROAD, SOUTH EXTN. PART 1, NEW DELHI: 110049

DD / UTR No.

mm/ dd/ yyyy

Bank Name

  • Content sharing agreement
  • 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 hereby agree to all terms and conditions of membership and give my consent to use the above mentioned data for organisational purposes and/or other statutory compliances as that may be deemed necessary by Central/State Governments.
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