1. Name of the Company:
2. Business profile: (attached a soft copy of Company Brochure):
3. Name of the CEO and his contact details (email address and mobile phone number etc):
4. Name and contact details of the representative nominated to be a Member of CPSI Executive Body: {Name, designation, email address and mobile phone number etc}.
5. A soft copy of Company’s official Logo should be attached.
6. Details of Cheque / DD of Rs. One Lakh {USD 2000 for overseas companies} plus 18% GST (one-time fee). GST of 18% is applicable to all Companies.
• For wire / bank transfer (CPSI Bank details will be provided on request)
• Cheque / DD should in favour of the Coal Preparation Society of India to be mailed / couriered to the address given below:
• Mailing address:
Coal Preparation Society of India,
1332 Sector – A, Pocket – B,
Vasant Kunj,
New Delhi – 110 070, India

Signature ………………………. Date …………………………………

7. Name:
8. Professional qualifications:
9. Present employment details: (Name of the company, designation, job profoile etc.)
10. Contact details (Postal address, e-mail ID and mobile phone number etc):
11. Any other details to support applicant’s membership request:
12. Details of Cheque / DD of Rs. Ten Thousand {USD 200 for overseas companies} plus 18% GST (one-time fee). GST of 18% is applicable to all Companies.
o For wire / bank transfer (CPSI Bank details will be provided on request)
o Cheque / DD should in favour of the Coal Preparation Society of India to be mailed / couriered to the address given below:

Mailing address:
Coal Preparation Society of India,
1332 Sector – A, Pocket – B,
Vasant Kunj,
New Delhi – 110 070, India

Signature ………………………. Date …………………………………