Please sign and submit the application with company seal and required documents / cheque/DD/ payment details to CHEMEXCIL Head Office on mentioned address. | Address: Jhansi castle, 4th floor, 7-Cooperage Road,Mumbai 400001 Tel: +91 22 22021288 / 330 / 22825861. Fax: +91 22 22026684 Fax: +91 22 22026684 Email: membership@chemexcil.gov.in web: https://chemexcil.co.in CIN: U91110MH1963NPL012677 GSTIN: 27AAATB3875E1ZT

Application Form

Application Form status testing
Member Details
Steps
  • 1 Company Information
  • 2 Addresses
  • 3 Products / HS Codes
  • 4 Upload Documents


Basic Information Go Back (Click Go Back And Re-enter IEC And Company Name To Edit)
1 Name of the Applicant Firm :
2 Address of the Applicant Firm Line 1 :
3 Address of the Applicant Firm Line 2 :
4 Region of the Applicant Firm :
5 State of the Applicant Firm :
6 City of the Applicant Firm :
7 Postcode of the Applicant Firm :
8 Tel: (with STD Code) :
9 Fax: (with STD Code) :
10 GST No :
11 Mobile No :
Steps
  • 1 Company Information
  • 2 Addresses
  • 3 Products / HS Codes
  • 4 Upload Documents


Other Information
12 E-mail :
13 Name of contact person :
14 Designation of contact person :
15 Mobile No of contact person :
16 Landline No of contact person :
17 Email Id of contact person :
18 IEC No. of the firm. :
19 Customer ID (UUID) as per ECHA Invoice :
20 Chemexcil Membership Code :
21 a. Company Category as per CHEMEXCIL Membership Records :
21 b. Company Category as per ECHA ( LSM/ MSM/ SSM/ MICRO SM) :
22 Status of Membership subscription fees paid for 3 years Receipt No. Date
: Not Applicable
: Not Applicable
: You have not paid current year membership fee .
23 Export House Certificate, if applicable :
Certificate No :
Issue Date :
Valid Upto :
24 Company Export Turnover in Rupees F.Y. () (IN Rs.): F.Y. () (IN Rs.): F.Y. () (IN Rs.):
25 RCMC Details :
RCMC No :
Issue Date :
Valid Upto :
Steps
  • 1 Company Information
  • 2 Addresses
  • 3 Products / HS Codes
  • 4 Upload Documents


Details


Export Data for registered Product in the country of registration
Sr.No Product Name HS Code FY (In USD Million) FY (In USD Million) FY (In USD Million)
1

 Add More




Total Export Data for registered Product (Worldwide exports).
Sr.No Product Name HS Code FY (In USD Million) FY (In USD Million) FY (In USD Million)
1

 Add More




Details of manufacturing license issued by the Licensing Authority (in India) for the substance(to be enclosed )
Sr.No License No Date Issuing authority
1
 Add More
Details of the substances registered by your firm
Sr.No Substance Name HS Code CAS No. Tonnage Band EC No. Submission No. ECHA Registration Date Upload
1
 Add More

Note - Please upload visible Documents. File format (PDF,JPEG) and File Size Maximum 10 MB
Details of Registration fees paid by your firm to ECHA
Sr.No Substance Name ECHA Regn fees paid in Currency ECHA Regn fees paid in Exchange Rate as per Bank Transaction copies
ECHA Fees
(Amount in Rs )
(A)
 LOA Fees paid in Currency LOA Fees as per LR Invoice or Data fees as per Lab invoice Exchange Rate as per Bank Transaction copies
LOA Fees
(Amount in Rs )
(B)
 Consultancy charges paid in Currency Consultancy charges as per consultant’s invoice Exchange Rate as per Bank Transaction copies
Consultancy charges
(Amount in Rs )
(C)
 Add More 1
Total
Registration Total Amount (A+B+C) = Rs. /-
50% Of Registration Amount = Rs. /-

Steps
  • 1 Company Information
  • 2 Addresses
  • 3 Products / HS Codes
  • 4 Upload Documents


Upload Documents

Upload Documents



Note - Please upload visible Documents. File format (PDF,JPEG) and File Size Maximum 10 MB
Steps
  • 1 Company Information
  • 2 Addresses
  • 3 Products / HS Codes
  • 4 Upload Documents


Summary page


Please verify your information below.

Declaration

I solemnly declare that the particulars given in the above statement are correct. I bound myself and the company accountable and responsible for any incorrect Information given in the above statement and shall immediately refund the amount received on the basis of wrong information provided in the above statement. I certify that the claim is as per the provisions of the MAI guidelines of the Dept of Commerce, MoC&I and the registration charges incurred to us has not been claimed or reimbursed elsewhere. We further certify that our claims are submitted to CHEMEXCIL within 45 days from the date of registration.


Signature With Company Seal :
Name :
Designation :




Countersigned by MD / CEO of the company :
Signature With Company Seal :
Name:
Designation :
Place :
Date :