Indian Council Of Emergency Life Skills

Membership Application Form (Commercial Category)

Instructions: Please fill in block letters. Attach self-attested copies of all required documents.

1. Establishment Details

Name of the Shop/Business

Type of Business

Shop & Establishment Reg. No

GSTIN

State

City

Pin Code

Registered Address

Office Contact No (WhatsApp No preferrable)

2. Proprietor / Authorized Signatory Details

Name

Designation

Mobile Number

Whatsapp Number

3. Staff & Safety Information

Total Number of Staff Members

First Aid Kit Available?
Yes No

4. Membership Category

Annual Membership
Lifetime Membership
Institutional Partner

Declaration

I hereby declare that the information provided above is true to the best of my knowledge.

Date

Place