NATIONAL SAFETY COUNCIL OF INDIA - APPLICATION FORM FOR INTERNATIONAL CORPORATE MEMBERSHIP

New Membership

1) Name and full address of the Organisation

Organisation Name

Address

2) Name and Designation of the

(a) Chief Executive/Occupier

(b) Executive In-charge of Safety Department

(d) If your establishment is a unit of any multi-unit organisation, please give full address of the Corporate Office

3) Category of Organisation

Public Ltd.

Pvt. Ltd.

Partnership

Small Scale

Large Scale

C)	Employee Organization

D)	Professional Research Body

4) Whether the Organisation is a part of a Multi - National Company

Yes

5) Whether the Organisation is a Major Accident Hazard Installation

Yes No

6) Main Product(s) manufactured/Activity undertaken/Service offered

9) Number of Employees (Including officers, staff and workers) or No. of Members in the case of Employer's Organisation

10) Membership Fee Payable

***(Entrance Fee)

(Annual Subscription)

(Total)

*** Entrance Fee forms the Corpus of the Council.

11) Payment Option (In favour of National Safety Council)

Check/Demand Draft along with copy of this duly filled-in form to be sent to
The Director General, National Safety Council
Plot No.98-A, Institutional Area,
Sector 15, CBD Belapur,
Navi Mumbai - 400 614

Enclosed DD Number *

Drawn On(Bank and its branch) *

Amount *

Date

(mm/dd/yyyy)

Cheque Number *

Drwan On(Bank and its branch *

Amount *

Date *

(mm/dd/yyyy)

Transaction ID(UTR ID) *

IFSC Code *

Amount *

Date *
(mm/dd/yyyy)

Proceed To Submit Button To Complete The Order.

***(Entrance Fee)	(Annual Subscription)	(Total)
*** Entrance Fee forms the Corpus of the Council.

Enclosed DD Number *
Drawn On(Bank and its branch) *
Amount *
Date	(mm/dd/yyyy)

Cheque Number *
Drwan On(Bank and its branch *
Amount *
Date *	(mm/dd/yyyy)

Transaction ID(UTR ID) *
IFSC Code *
Amount *
Date *	(mm/dd/yyyy)