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APPLICATION FOR MEMBERSHIP

(All Cages must be filled)

1. Name of the Company / Firm ………….…………………………………………………………………………………………

2. Address (Head Office) ……………………………………………………………………………………………………

(Factory) ……………………………………………………………………………………………………

3. Name of Contact Person & …………………………………………………………………………………………………… Designation 4. Telephone Nos. …………………………………………………………………………………………………… 5. Fax …………………………………………………………………………………………………… 6. E-mail …………………………………………………………………………………………………… 7. Cellular No. …………………………………………………………………………………………………… 8. Web-site …………………………………………………………………………………………………… 9. SLTB Registration ………………………………………………………………………………………………….. 10.Products exported …………………………………………………………………………………………………..

11. Names of Directors/Partners Designation

(1).…..…………………………………………………………… ……………………………………………………….

(2) …………………………………………………….…………. ………………………………………………………..

(3) ……………………………………………………………….. ………………………………………………………..

(4) ……………………………………………………….………. ………………………………………………………..

12. Date of Incorporation/Registration :………………………..

13. Registration No. ………………………………..

TEA EXPORTERS ASSOCIATION Ceylon Chamber of Commerce, 1

st Floor, No. 50, Navam Mawatha, Colombo 2.

Email: admin@teasrilanka.org

14. Year of commencement of Business ……………………………………………………………………………………………

15. Annual Tea Export Volume and Turnover (Last Three Years)

2016 MT ........................... Rs …………………... 2017 MT ........................... Rs …….....................2018 MT ........................... Rs ………………......

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16. Name of Representative :………………………………..……. 17. No. of Employees : 18. Designation : ………………………………………………….. 19.. Capital Authorised Rs.: …………………………………… Paid up Rs. : …………………………..………………………. 20. Bankers ……………..…………………………………………………………………………………………………………………….. 21. Auditors Certification We certify that the information submitted in question Nos. 15 & 20 are correct.

Name :

Designation :

Signature :

Rubber Stamp :

Date :

22. Names of other Chambers or Associations of which the applicant is a member

(i) …………………………………………………………………………………………………………………………………. (ii) ……………………………………………………………….………………………………………………………………….

(iii) ………………………………………………………………….………………………………………………………………..

The Proposer should be your Banker or a Member of the Tea Exporters Association (TEA) and should also be seconded by a Member of the Tea Exporters Association. Annual Subscription is payable on or before June each year

We hereby apply to be enrolled as a member of the Tea Exporters Association and we agree to abide by the constitution and Rules of the Chamber from time to time in force. We enclose Cheque * / Cash for Rs. …………………………..covering Annual Membership Subscription and Enrolement Fee. ………………………………………………… (Signature of Applicant with Rubber Stamp)

Date :…………………………………………

* To be drawn in favour of "Tea Exporters Association"

Total Males Females

Total No. of Employees

Executives

Clerical

Production/Factory

Proposer's Name …………………………….……………………… Seconder's Name ………………..……………………………………… Company ………….………………………………………………….. Company…………..………………..…..……………………………….. Signature ………….…..…………………………………………. … Signature……..…………..……………………………………………….

FOR OFFICE USE ONLY -

Annual Membership Subscription Rs. 45,000.00 Enrolment Fee Rs. 50,000.00 Total Rs. 95,000.00

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