Appendix 19 A (For Exporter)
Request For Registration Cum Membership Certificate
Application Date  Membership Year 
Applicant Type 
Name Of Applicant *   
Main Line of Business  Constitution 
PAN Number *    Establishment Date    
IEC Number 
Issuing Authority  
IEC Issue Date  IEC Place 
Website  Goods Description 
Annual Business Turnover 
(Rupees in lacs)
 a. Export  
 b. Domestic  
Address of Applicant (Reg.Office in case of Ltd. and Head Office for others)
Address *  State 
Pin Code 
Email ID  Telephone 
Address for Correspondence
Address *  State 
Pin Code 
Contact Person * 
Mobile  Telephone 
Email ID  Fax 
Branch  & Factory Address
Office Type  Name Office  
Address   State 
Pin Code 
Email ID  Telephone 
Details of Directors/Partners/Proprietor/Karta/Parceners
Authority Type    
Name   Father's Name  
Residential Address  State 
Pin Code 
Telephone Number     
Cheque/DD should be drawn in favour of 'Powerloom Development & Export Promotion Council'
Payment Type  Amount    (Inclusive of Entrance Fees)
DD/Cheque No. *  Date * 
Bank Name *  Payable at Mumbai  Branch  
Certificate Type
or Council Name 
Certificate No.  Valid Upto    
Upload Documents (accepted only .gif, .jpg, .tif or .pdf)
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  1. I/We here by solemnly declare that the above stated information Is true and correct. I/We undertake, without any reservation, to :
    1. Abide by the terms of the registration certificate grant to us on all our exports
    2. Agree to abide by any code of conduct that may be prescribed:
    3. Agree to abide by export floor price condition that may be stipulated by the Registering Authority:
    4. Furnish without fail monthly returns of exports including Nil returns to the Registrering Authority by 15th day of the month following the quarter.
  2. I/We further understand that our registration is liable to be cancelled in the event of breach of any of the undertakings mentioned above.
  3. I /We solemnly declare that we have applied to the Export Promotion Council which pertains to our main line of business. In case I/we have applied to any Council,the application has been made within the purview of the provisions of para 2.63 of the handbook of procedures(Vol1)
  4. I/We agree to send self certified copy of all above uploaded documents along with Cheque/DD and membership form duly signed and stamped. Kindly note you can print the membership form filled by you online by clicking on print button when acknowledgement number is generated. Alternatively you will get the print option for printing the membership form filled by you by clicking on the 'Track online RCMC' at home page of our website.
Authorised Signatory *
Tele No.
Email ID