Membership Application Form
Address, Telephone and Fax  
:
Shareholders & Country 1.   
  2.   
  3.   
  4.   
Supervisory Board 1.   
  2.   
  3.   
  4.   
Overseas Company / Organization Affiliation (if any)
Management Board / Authorized Officials to represent ECAII
Name Designation Tel./Fax Email
I / We wish to apply for the membership of Economic Association of Indonesia & India.
Rp.  
Rp.  
31 / 12 /
 
Bank SBI Indonesia
Jln. Pasar Baru Selatan No.19
Jakarta Pusat
Account Name : India Indonesia Chamber of Commerce (INDCHAM)
Account No. : 002-300-6243
 
Date :
24-09-2017 01:18:56

Place :
Authorized Signatory
Name :
Designation :
 
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