NATIONAL SAFETY COUNCIL OF INDIA

CORPORATE MEMBERSHIP

Membership Renewal

1) Name and address of the Organisation
Address
FY Amount GST(18%) Total
Arrears FY Amount GST(18%) Total
Arrears FY Amount GST(18%) Total
2) 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)