The Executive Director
ICC India
Federation House,
1 Tansen Marg
New Delhi 110 001

Dear Sir,

We have the pleasure of applying for the Patron Membership of ICC India as also of the International Chamber of Commerce, as per following details.

Name of Company ________________________________________________

Address :________________________________________________________

________________________________________________________________

City _________________________________ Pin ________________________

Tel :_________________ Fax :________________ E-mail :________________

Address in Delhi (if any)_____________________________________________

________________________________________________________________

Tel : ______________Fax : _____________ E-mail:______________________

Our Chief Executive is ______________________________________________

Designation :_____________________________ Tel :_____________________

Fax : ________________________ Email : _____________________________

Together with our Associates _________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

{Fill in the name/s (with address) of Associate/s, if any, not exceeding 4 in number} 

We are engaged in __________________________________________________

_________________________________________________________________

(Please specify the line of activity in which the undertaking is engaged.)

We agree to abide by the Memorandum and Articles of Association.

We nominate Mr/Ms/Dr/etc._________________ Designation_______________ as our representative on the Committee of ICC India. All communication to him/her may kindly be sent at:

Address: ________________________________________________________

__________________________________________________Pin___________

Tel:_______________ Fax:________________ E-mail:____________________

We are sending herewith a Cheque on a Delhi Bank or a Demand Draft in favour of ICC India, payable at Delhi bearing No._____________ dated _________ for Rs.1,00,000/- (Rupees One Lakh only) being the annual subscription which, in our opinion, is payable according to the Articles of Association and request you to place our application before the Committee of the ICC India at the earliest and look forward to receiving your acceptance of the same.

Yours truly,

_____________________
Name and Designation

________________________
Signature of the Applicant