2nd Floor, West Wing, Offtel Towers No. 1, B/h. Shop-N-Shop Plaza,
Nr. Vivekanand Memorial, R. C. Dutt Road,
Alkapuri, Vadodara - 390 007.
Phone: +91 93752 26729/93753 26729 | Website:www.eximclub.org
E-mail: eximclub@eximclub.org

Membership Application Form (Inter State)

To
The President
EXIM CLUB

Membership Category *

Corporate Institutional Individual

Name of Organization

Address

Contact Number

E-mail ID

MD/CEO/Head/Name

Designation

Contact Number

E-mail ID

Representative Name

Designation

Contact Number

E-mail ID

Sales Turn Over

(Rupees In Crore)

GST Number

IEC Number

PAN Number

Classification

MSME LARGE MNC 100%EOU Other

Type of Industries

Chemicals Pharmaceuticals Engineering Plastics
Food Processing Machinery Other

Activity

Manufacturing Professional Service Provider Trading
Other

Enclosed

Cheque NEFT UPI QR Code

Bank Details: Bank Name: Union Bank of India | Branch: Alkapuri | A/C No.: 520141001227201

IFSC Code: UBIN0903361

Cheque to be drawn in favor of "EXIM CLUB"

We agree to abide by the constitution of Exim Club in force from time to time.

Membership Application Form (Inter State)

To The President EXIM CLUB

To
The President
EXIM CLUB