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Samadhan

The document appears to be a membership form for an industry incubator program run by the Ministry of Micro, Small and Medium Enterprises in India, offering different levels of membership for individuals, startups, enterprises, institutions, and experts, with fees ranging from Rs. 2360 to Rs. 59,000 depending on the membership level selected. The form collects contact and business information from applicants and outlines the terms and conditions of membership in the incubator program.

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vikrameye
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148 views

Samadhan

The document appears to be a membership form for an industry incubator program run by the Ministry of Micro, Small and Medium Enterprises in India, offering different levels of membership for individuals, startups, enterprises, institutions, and experts, with fees ranging from Rs. 2360 to Rs. 59,000 depending on the membership level selected. The form collects contact and business information from applicants and outlines the terms and conditions of membership in the incubator program.

Uploaded by

vikrameye
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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An Industry Incubator under PPP Mode with Ministry of MSME

Government of India

MEMBERSHIP FORM

Full Name___________________________________________________________________________________
Photo
Date of Birth DD MM YY

Mailing Address______________________________________________________________________________

__________________________________________________________________________________________

Mobile No.__________________________ Whatsapp No.____________________________

Email id.____________________________ Website_________________________________

Name of the Existing Organisation________________________________________________________________

Designation _________________________________________________________________________________

Nature of Business of existing Enterprise_________________________________________________________

Purpose of Incubation New Business Connect Knowledge

Membership plan

General Plan – For Individual/Enterprises/Startups


Incubatee Membership Fee Rs. 2360/-
Executive Membership Fee Rs. 5900/-
Associate Membership Fee Rs. 11800/-
Corporate Membership Fee Rs. 59000/-

Professional Plan – For Institution/Suppliers/Experts


Associate Membership Fee Rs. 11800/-
Corporate Membership Fee Rs. 59000/-

The above membership fee amount is inclusive of GST calculated @ 18%

The information given above is true to our knowledge. We agree to inform you in writing of any change in the particulars stated above.
We have read and understood the terms and conditions and agree to abide by the same.

Dated: Signature with rubberstamp

*Membership once issued is non refundable


Payment may be made by Cheque or Demand draft, drawn in favour of “Institute for Industrial Development”
For online payment/RTGS: Institute for Industrial Development, Union Bank of India,
U.P. Rural Housing Board Branch, Lucknow,
CA No. 521301010036458 IFSC Code – UBIN 0552135
______________________________________________________________________________________________________

MSME Helpline: 7408733333, 7607655555 Email us: [email protected]

Delhi Office: Multi Disciplinary Training Center, Gandhi Darshan, Rajghat, New Delhi 110002
Lucknow Office: Samadhan Tower, 27/B/1, Gokhley Marg, Lucknow (UP) 226001

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