Membership Application form
(Please fill in Capital letters or type)

Name of Applicant:

Date of Birth:

Nationality:       

National Tax Number:

N.I.C./Passport Number:

Name Of Company/Institution :

Designation:

Office Address:
 

Home Address:
 

Tel (Office):

Tel (Residence ):

Fax:                                                E-mail:                                  Mobile:

Present activities related to Belgium:

Proposed activities related to Belgium:

Proposer's Name:
Company Name & Address:


                                                                                                Signature:________________

Seconder's Name:
Company Name & Address:

                                                                                                 Signature:________________

Admission Fee : Rs. 6,000
Annual Subscription: Rs. 6,000 (January to December)

Crossed Cheque No._____________ dated_____________ for Rs. 12,000 is attached.

- I Agree to comply with the Constitution of the Pakistan-Belgium Business Forum.
- Proposer and Seconder must be members of Pakistan-Belgium Business Forum.
  To see our member list please click here.
- Any changes in the above information may kindly be notified to the Forum promptly.

Date:________________                                                         Signature:__________________

FOR OFFICE USE:

Approved:                                                Comments: