Annexure A Form
Annexure A Form
Annexure A Form
Mumbai Office: 702 A Sorento, Shanti Park, Ghatkopar East, Mumbai 400077, India. Tel: +919137784411, Email: [email protected] Web: www.icib.org.in
Name : ____________________________________________________________
Address : ____________________________________________________________
Phone : ____________________________________________________________ Paste Photo
Mobile : ____________________________________________________________ Here
Email : ____________________________________________________________
Website : ____________________________________________________________
Nature of Business / Profession:_____________________ Sector:_______________
Rotary Membership Number:___________________________________
Rotary Club Name and district: ___________________________________________
• A brief profile
• Government approved Identity Card along with Address Proof
• Business Registration copy (for corporate or company memberships)
• Membership certificate will be issued after scrutiny and approval by executive committee.
• Please make membership fees payable to “Indian Chamber of International Business”.