INDEPENDENT CONSULTANTS AND ADVISORS ASSOCIATION

[CIN - U9300WB2016NPL210296]

Application form for individual Membership for the year *FY 2023-24(1st April 2023 to 31st March 2024)

Date of Birth*:

Blood Group*:

Profile Image* :

Surname*:

First Name*:

Middle Name:

Nationality:

Registration No *:

Reg. No Type *

PAN No*:

Business Name :

Business Address:

City *:

State*:

Pin Code *:

Tel No (Office) :

Mobile No :

Whatsapp No* :

Email id :

Gmail id:

Website:

Nominee*:

No. of Sub Brokers:

No. of operational locations:

Res. Address :

City :

Pin Code :

Qualification :

State:

Membership Category*

Individual

Honorary Member- Nil /-

Premier (Life)=22222.00 /-

Premier (Life) - AMC=599.00 /-

Primary (Annual)=1499.00 /-

Additional Member=1499.00 /-

Premier (Life) - Regular=599.00 /-

Non Individual

LLP | PVT.LTD.=29999.00 /-

Additional members=2499.00 /-

Please upload Payment success image* :

Upload ARN Card/RIA/CFP/IRDA/POS code/STOCK Broker/Subbroker Document*:

Bank Details for Offline Payment:

C/A-Name: INDEPENDENT CONSULTANTS & ADVISORS ASSOCIATION

AXIS Bank Ltd.

BBD Bag, Kolkata-700001
C/A no- 921020055460758
IFSC code:UTIB0001138
Micr code:700211056

I agree and abide by the Terms and conditions

Independent Consultants & Advisors Association

INDEPENDENT CONSULTANTS AND ADVISORS ASSOCIATION

Individual

Non Individual

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