ࡱ> m *bjbj:: 4jX\X\!<bL L (((8`t(Nh``pppl l l 3N5N5N5N5N5N5N$PRFYNB*xl B*B*YNppnN///B*8pp3N/B*3N//F{IpMD0+H8NN0NGH4S&-HSp{IS{Il $#>/%'l l l YNYNn.0l l l NB*B*B*B*Sl l l l l l l l l L > : The Secretary Automotive Component Manufacturers Association of India 6th Floor, The Capital Court Olof Palme Marg Munirka New Delhi-110 067 Dear Sir, ENROLLMENT AS ASSOCIATE MEMBER We wish to be enrolled as a member of the Automotive Component Manufacturers Association of India under the Associate member category and are hence submitting this Application. We agree to abide by the Rules & Regulations of 17Թ and further agree to Provide data for the Annual Statistical Return, 17Թ Buyers Guide, Business outlook survey, 17Թ Membership survey and any other data / information which the Association or its authorized agencies may ask from time to time. We declare that the information provided by us in the Form is complete in all respects and true to the best of our knowledge. We declare that our company (Applicant) is not fulfilling the Criteria of an "Ordinary Member" of 17Թ. Company Name: Authorized Person Name: (Company Stamp) For and on behalf of Date : _____________________ ___________________________ Signature & Designation * Proposed by : * Seconded by : Name : ___________________________ Name : ______________________________ Company : ________________________ Company : ____________________________ Note : Both Proposer and Seconder should be an Ordinary Member of 17Թ and this Form should be signed and stamped by their authorised representative only. ...... Encls. : 1) Cheque/D.D. No. ______________________dated____________________ Rs. ________ drawn on ___________________________________________ towards admission fee and subscription for the current year and payable to Automotive Component Manufacturers Association of India. (See attached Eligibility Criteria for Charges) Certificate of Incorporation from ROC (Registrar of Companies)/ Partnership Deed in case of a Partnership firm Annual Report, Audited Balance Sheet and Profit and Loss Account for Last 1 year. One set of Product Catalogue/ Web-link to the E-brochure Copy of Companys GSTIN Registration Certificate & PAN Card. Note : It is mandatory to provide details for all queries to ensure quick processing. Please ensure that the Form is accompanied with all relevant enclosures. PM_33_F2 Rev. No. 01 FOR OFFICE USE ONLY (Secretariat) Admitted on : Date ______________________Place___________________ Rejected due to : __________________________________________________ Payment due (if any) : __________________________________________________ ____________________________________ (Signature: Head, Membership Department) ___________________________________ (Date) (Regional Office) Regional Chairpersons Approval : ________________________ (Signature) ________________________ (Date)   Automotive Component Manufacturers Association of India (THIS FORM SHOULD BE SUBMITTED TO THE RELEVANT 17Թ REGIONAL OFFICE) MEMBERSHIP APPLICATION 1) a) Company Name : _____________________________________________ _____________________________________________ b) Address of main operations _____________________________________________ in India c) Location of other offices: _____________________________________________ in India/Global Head Quarter (in case of MNCs): d) Address to which : _____________________________________________ communications are to be sent _____________________________________________ _____________________________________________ Phone (s) : ___________________________________________________ Fax : ___________________________________________________ Note: Please provide Email IDs that are monitored, so as not to miss any important communications / notifications. E-mail (for 17Թ services): _________________________________________________ E-mail (for 17Թ membership matters) : _____________________________________ E-mail (for finance / taxation): ______________________________________________ Website : ____________________________________________________ PAN No. : ____________________________________________________ e) Address of Registered Office : _____________________________________________ _____________________________________________ Phone (s) : ______________________ Fax ______________________________ E-mail : ________________________________________________________ f) Year of incorporation/ : _________________________________________________ establishment g) Year of commencement: ___________________________________________________ of Business related to Automotive Industry h) Ownership of the company: (I) Domestic: Yes/No (II) Joint Venture: Yes/No (If yes, then the name of the company/ies and country/ies) (III) Foreign: Yes or No (If Yes, Origin of Company) i) Nature of Entity: i) Sole Proprietorship [ ] ii) Partnership [ ] iii) LLP[ ] iv) Ltd. (Non-Listed) [ ] v) Ltd. (Listed in BSE/NSE) [ ] j) Type of company: i) Start-up [ ] Please note a company should be less than 3 year old while applying for membership. ii) Old Entity [ ] k) Trade Mark : _________________________________________________ l) Business Turnover i) Domestic : __________________________________________________ ii) Export : __________________________________________________ m) Name of Managing Director/: ________________________________________________ Directors/Partners/Proprietor (With exact designations) n) Name of Director/Partner/:_______________________________________________ Senior Executive authorised to represent on behalf of the organisation (with exact designation) o) Name of Chief Executive : ____________________________________________ Marketing -in-charge : ____________________________________________ Export-in-charge : ____________________________________________ (with exact designations) HR-in-charge with Email ID: ____________________________________________ 2. Is your company certified to ISO 9000, IATF 16949, OSHAS 14000 and any other certification applicable to companys line of business? If so, please give details of the certification and also enclose a copy. Certificate Certifying Agency Date of Issue Validity 3. Foreign Collaboration (s), if any Name of collaborator Nature of collaboration (Financial, Services Equity and country Technical, both or others) provided Share(%) (give details) or 100% Subsidiary 4. Our activities directly/indirectly related to Automotive Industry Manufacturers/ Job Work of auto accessories, spare parts Information Technology / Digital Services Designing Logistics Consulting Companies Technical Service Providers Advisory Services Tools & Dies Capital Goods Telematics Lubricants l) Others 5. What product/service is your company supplying/providing to the automotive industry (please list and give details) Service Details Directly/Indirectly 6. Names of Key Customers: Company name Services provided _____________________________________________________________________________________ 7. Turnover for last 2 years (Value in Rs. Lakhs) Year Current Year Auto Related Turnover    (Please mention Year) a) Domestic i) OE /Tier-1/ Tier-2 : Rs. customers ii) Other customers eg. : Rs. Replacement market etc. (Please specify) b) Exports i) Overseas OE/Tier1/ : Rs. Tier2 ii) Other overseas : Rs. customers (Please specify) Total (in Rs. Lakhs) : Note : This info shall be kept strictly confidential and use only for internal purposes 8. % Share of Automotive Business Out: of Total Business 9. Membership with other Associations/Bodies  Signature: ___________________________ Form filled by: _________________________________ Date : ___________________________ Designation: ___________________________________      PM_33_F2 Rev. No. 02 PAGE  FOR OFFICE USE ONLY (Secretariat) 1. Reason why the applicant company is not fulfilling the eligibility criteria for "Ordinary Member" 2. Does the company expect to be eligible for "Ordinary Member" in Future? Yes No 3. If so, approximate date/ period, when eligibility for Ordinary Member is likely to be achieved. HJ ! 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