This membership form is for the Gujarat Chemical Association, which offers two types of memberships: Life Membership for Rs. 20,000 and Corporate Membership for Rs. 25,000. The form requests information about the applicant such as company details, number of employees, annual turnover, and references from current GCA members. It also seeks to confirm if the applicant is a manufacturer or trader and will abide by the association's memorandum and articles if accepted.

1. MEMBERSHIP FORM
Category of Membership Life Member Corporate Member
Membership Fees Rs. 20,000 Rs.25,000
Name of the Firm :
Address :
Telephone No. Office : Residence: Fax No:
E-mail ID : Mobile No.
Status : Proprietor / Partnership / Private Limited / Limited Company / Any other
Name of Partners /Proprietors /Directors Date of Birth
1)
2)
3)
Are you a Manufacturer ? Yes / No . Products *
Are you a Trader ? Yes/ No. Products*
* Attach Product List
No. of Employee: Approx. Annual Turn over : Rs.
Representative for
Association
Name Designation Signature
1)
2)
PAN No. ( Attach Copy )
Membership with other Assosn.:
Recommended By
(Member of GCA )
Name Organization Signature
Proposed By :
Seconded By :
Name & Signature of Applicant:
I/We desire to be Ordinary /Life/Patron/Corporate Member of your Assn. I/We confirm to abide the Memorandum & Articles of the Assn.
Cheque No. Dtd. RRs. Bank
Platin
um
Jubile
e 75
Year
ESTD-
1947
GUJARAT CHEMICAL ASSOCIATION
Shri Rasiklal Vasa Chemical Chamber, 3
rd
Floor, “Nikumbh” Complex
Nr. Mardia Plaza, Off. C G Road, Ahmedabad – 380 006. Phone : 079 26565749
E-Mail : info@gujaratchemicalassociatin.org Website : gujaratchemicalassociation.org
Estd : 1947
Office Use
Accepted Date Membership No. Signature : President / Secretary
GCA IS COMMITTED TO MAKE GUJARAT A GLOBAL CHEMICAL HUB .