MEMBERSHIP APPLICATION FORM

Odisha Chamber of Commerce & Industry

Section 1: Basic Information

1. I / We *

Address *

Phone(s)

Mobile *

E-mail *

Website

Passport Photo

Affix passport
size photo
(Self Attested)

Section 2: Membership Category

Wish to enlist myself/ourselves as member of the chamber in the following category:

Please tick (✓) the appropriate box

Member

Member Association

Corp. Member

Life Member

Associate Member

Other

Section 3: Entity Type

3. I am / we are a / an:

Please tick (✓) the appropriate box

Individual

Prop. Firm

Part. Firm

Pvt. Ltd. Co.

Ltd. Co.

Association

Date of Birth (In case of Individual)

Year of Establishment (In case of non-Individual)

Section 4: Main Activity

4. My / our main activity is in the field of:

Please tick (✓) the appropriate box

Industry

Trading

Exports

Service Industry

Professional

Any Other

Applicant Signature

Date *

Name *

Select Fee Category *

Please select your membership fee category:

Category	Regd. Fee (₹)	Admission Fee (₹)
Membership (Individual/Firm/Co.)	1,000/-	5,000/-
Member Association	1,000/-	10,000/-
Corporate Member	1,000/-	25,000/-
Life Member	1,000/-	1,00,000/-
Associate Member / Start up	1,000/-	NIL

All fees are in Indian Rupees (₹). Click on a row to select your fee category.

We have read the aims of the chamber and agree to abide by its constitution, rules & regulations in force from time to time (Memorandum & Article of Association). *

I/We understand that my / our membership is subject to approval by the managing committee / Executive body of the chamber. *

विकसित ओडिशा, विकसित भारत

Developed Odisha, Developed India