ࡱ> |~{m .bjbj:: 4hX\X\\&J     8VT9h>>"```.  *9,9,9,9,9,9,9$;=FP9 ***P9  ``e9...* ` `*9.**9..4l6`PSD+:^6*9{9096*>+>T6> 6d".%,'P9P9Z-N9****> > :  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 MEMBER We wish to be enrolled as a member of the Automotive Component Manufacturers Association of India under the Ordinary member category and are hence submitting this Application. We agree to abide by the Memorandum and Articles of Association 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. 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 members 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) Annual Report/ Audited Balance Sheet/ Certificate from Auditor certifying your company's GST (Gross Sales Turnover) for Last 2 years. One set of Product Catalogue/ web-link to the E-brochure. SSI Registration Certificate (if applicable). 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. 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 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. : ____________________________________________________ c) Address of Registered Office : _______________________________________ _______________________________________ Phone (s) : ______________________ Fax ________________________ E-mail : _________________________________________________ d) Main Plant Address: ____________________________________________ ______________________________________________ Phone (s) : ______________________ Fax ________________________ E-mail : _________________________________________________ e) Year of incorporation/ : __________________________________________ establishment f) Year of commencement : ____________________________________________ of commercial production g) 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) h) Nature of Entity: i) Sole Proprietorship [ ] ii) Partnership [ ] iii) LLP[ ] iv) Ltd. (Non-Listed) [ ] v) Ltd. (Listed in BSE/NSE) [ ] h) Trade Mark : __________________________________________ i) Name of Managing Director/: ____________________________________________ Directors/Partners/Proprietor (with exact designations) j) Name of Director/Partner/:___________________________________________ Senior Executive authorised to represent on behalf of the organisation (with exact designation) k) Name of Chief Executive : ____________________________________________ Sales-in-charge : ____________________________________________ Export-in-charge : ____________________________________________ (with exact designations) HR-in-charge with Email ID: ____________________________________________ Registration a) MSME Reg. With State Director : Reg. No. : ________________________ of Industries or with the Development Commissioner Date : ________________________ for SSI or otherwise  b) The company is register as : Large Medium (if not MSME) c) Reg. Under Factories Act, 1949 Reg. No. : ________________________ Date : _________________________ Note: If a MSME unit, please enclose MSME Registration Certificate. 3. Is your company certified to ISO 9000, IATF 16949, OSHAS 14000? If so, please give details of the certification and also enclose a copy. Certificate Certifying Agency Date of Issue Validity 4. Manufacturing Plant (s) Address of the Name and Designation of Manufacturing Activities Plant(s) with head of the Plant (Products) Ph/fax/E-mail 5. Collaboration (s), if any Name of collaborator/JV Nature of collaboration (Financial, Products Equity Partner and country Technical, both or others) share(%) or 100% subsidiary Customer Profile Domestic Market Customer Name Vehicle Model Products Supplied (Including Replacement Market) Overseas Market Customer Name & Vehicle Model Products Supplied Country (Including Replacement Market) 7. Production achieved in the last three financial years Product Year : Year : _________________ _________________ Quantity Value * Quantity Value * (Value * in Rs. Lakhs) 8. Sales profile for last 2 years (Value in Rs. Lakhs) Year Year a) OEM : Rs. b) Replacement Market : Rs. c) Export : Rs. .... .... Total .... .... 9. Export performance for the last 2 years Year Export % of Export/Sales  for the last 2 years  Quantity Value 10. Financial Data (As at ) (Value in Rs. Lakhs) a) Reserve & Surplus : ________________________________________ b) Employment of Capital Land & Buildings : ________________________________________ Plant & Machinery : ________________________________________ R & D : ________________________________________ Working Capital : ________________________________________ Total : ________________________________________ Note : Annual Report/ Audited Balance Sheet/ Certificate from Auditor certifying your company's GST (Gross Sales Turnover) for the last 2 years are to be enclosed. 11. Employment (As on ) Skilled : _______________________________ Semi-skilled : _______________________________ Unskilled : _______________________________ Casual : _______________________________ Temporary : _______________________________ Supervisory : _______________________________ Managerial : _______________________________ R & D Staff : _______________________________ Note: All employees including those in the factory, office and field are to be included. 12. Material consumption during the last two financial years Type of HS Code Sourced Indigenously Imported Raw Material (6 digit) _____________________ ____________________ Quantity (MT) Value Quantity (MT) Value 13. a) Membership with other Associations/Bodies  b) Member of 17Թ Earlier Yes No 14. Awards/Certificates received, if any 15. 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