NATIONAL SAFETY COUNCIL OF INDIA

APPLICATION FORM FOR CORPORATE MEMBERSHIP

New Membership

1) Name and full address of the Organisation
Address
2) Name and Designation of the
(a) Chief Executive/Occupier
(b) Executive In-charge of Safety Department
(c) Person to whom NSC services are to be sent
(d) If your establishment is a unit of any multi-unit organisation, please give full address of the Corporate Office
3) Category of Organisation
A) Public Ltd. Pvt. Ltd. Partnership
B) Small Scale Large Scale
C) Employee Organization
D) Professional Research Body
4) Whether the Organisation is a part of a Multi - National Company
5) Whether the Organisation is a Major Accident Hazard Installation
6) Main Product(s) manufactured/Activity undertaken/Service offered
7) Electoral Constituency
8) Select Entrance Fees & Annual Subscription Category
Category Entrance Fee
(Rs.)		 Annual Subscription
(Rs.)
A) Companies/Organisations/Units employing:
I) Up to 50 persons Rs. 1,300.00 Rs. 1,900.00
II) From 51 to 100 persons Rs. 1,600.00 Rs. 2,200.00
III) From 101 to 500 persons Rs. 2,600.00 Rs. 3,400.00
IV) From 501 to 1,000 persons Rs. 3,700.00 Rs. 4,900.00
V) From 1,001 to 5,000 persons Rs. 7,700.00 Rs. 10,000.00
VI) From 5,001 to 10,000 persons Rs. 10,000.00 Rs. 15,400.00
VII) More than 10,000 persons Rs. 12,200.00 Rs. 18,500.00
B) Employer's Organisations having:
I) Up to 100 members Rs. 2,200.00 Rs. 4,900.00
II) More then 100 members Rs. 3,900.00 Rs. 7,300.00
C) Professional Institutions/Research Bodies:
I) Professional Institutions/Research Bodies Rs. 2,900.00 Rs. 5,800.00
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)
(GST)
(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

(mm/dd/yyyy)