ph a r m e xcil

FEE FOR MEMBERSHIP

Membership fees for various categories of members is as follows :
S.No.

Category of Members

Membership Fee

Service Tax (12.36%)

Rs.7,500/-

Rs. 41,208/-

Rs. 1,500/Rs. 2,500/-

Rs. 9,927/Rs. 11,489/-

1.

Large Scale Manufacturer

Rs. 30,000/- p.a.

3,708/-

2.
3.

Small Scale Manufacturer

Merchant Exporter

Rs. 7,500/- p.a.

Rs. 8,000/- p.a.

927/989/-

Entrance Fee

Total

Note : DD Should be drawn in favour of "Pharmaceuticals Export Promotion Council" Payable at

Hyderabad / Mumbai.
LARGE SCALE MANUFACTURER:
Member has to submit a certificate issued by the Secreteriat for Industrial Assistance.
SMALL SCALE MANUFACTURER :
Member has to submit SSI certificate issued by the Director of Industries.
Documents to be enclosed
Large Scale Manufacturer : IEC, PAN Card, Industrial Licence, Drug License, Brief Profile of the
Company, along with brochure.
Small Scale Manufacturer : IEC, PAN Card, SSI Permanent Registration, Drug License, Brief Profile
of the Company, along with brochure.
Merchant Exporter : IEC, PAN Card, Drug License, Brief Profile of the Company, along with brochure.

ph a r m e xcil

PHARMACEUTICALS EXPORT PROMOTION COUNCIL OF INDIA

(Setup by Ministry of Commerce & Industry, Govt. of India)
101, Aditya Trade Centre, Ameerpet, Hyderabad-500 038.
Tel. No. 040-23735462, 23735466, Fax : 040-23735464
E-mail : [email protected] Website : www.pharmexcil.com

APPLICATION FOR MEMBERSHIP

The Executive Director
Pharmaceuticals Export Promotion Council of India
101, Aditya Trade Centre,
Ameerpet, Hyderabad-500 038.
Dear Sir,
Kindly enroll us as Associate/Ordinary Member of Pharmaceuticals Export Promotion Council, in the following category
(please tick ( ) only one from the following).
LARGE SCALE MANUFACTURER

SMALL SCALE MANUFACTURER

MERCHANT EXPORTER

OTHERS (Specify

We enclose herewith a Cheque/D.D. No._______________________Dt

drawn on

)
For Rs.

Branch

towards

the membership subscription under the category in which we seek.

We have read the rules and regulations for membership of the Council and agree to abide by the same. We give
below the particulars of our firm :
1. NAME OF THE FIRM

2. POSTAL ADDRESS
(a) Head Office

3. TELEPHONE :
4. FAX :

EMAIL :

5. Under Which Panel does the applicants request to be indexed

Please tick any one of the following
Panel

Panel

II

Pharmaceutical Formulations (including Excipients, Veterinary Drugs etc.

Bulk Drugs & Drug Intermediates

Panel III

Herbal Products (including Ayurvedic, Homeopathic, Unani and Siddha Medicines

Panel IV

Biotech Products (including vaccines and recombinant products)

Panel

Pharmaceutical Services (including R & D, Clinical Trials, Medical Transcripts)

Panel VI

Healthcare Products (Including Surgicals, Diagnostics, Medical Devices etc)

Panel VII

Merchant Exporters (Traders, CROs)

7. Whether registered with Directorate of industries/SSI/SIA

Department of Industries, New Delhi/Food and Drug Administration (enclosed)
8. I.E. Code No.

Regn No.

Copy of PAN No. :

Date
(Please enclose photostat copy)

Date
(Please enclose photostat copy)

9. Name(s) and address(es) of the representative(s) in order of priority who shall excercise voting powers with
specimen signature as given below : (Compulsory)

NAME

DESIGNATION

SIGNATURE

1.
2.
3.
4.
I/We hereby declare that the particulars given above are true and correct to the best of my/our knowledge and belief.
I/We hereby agree to produce evidence in support of the information given above as and when the council requires.

Place :

Seal/Rubber Stamp with address

Signature of the applicant

Name/Designation.

(For Office use only)

Receipt No.

Membership No.

Date :

Date :

The party has paid the necessary fees and furnished all required documents. We may,therefore, accept their Membership
as

Under Panel

Dealing Clerk

subject to approval

Checking Officer

Executive Director

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APPLICATION FORM FOR REGISTRATION CUM MEMBERSHIP

File No.

Date :

The Director General

Pharmaceuticals Export Promotion Council,
101, Aditya Trade Centre,
Ameerpet, Hyderabad-500038.
Dear Sir,
Kindly register us as Manufacturer - Exporter / Merchant - Exporter of the Product (s) mentioned below.
1. Name of the Applicant (company)

2. Address of the Applicant (company)

i) Registered Office in case of Limited
companies and head office for others :
ii) Name and Address of the branches
if any

iii) Name and Address of the Factory

:
:
:
:

E-mail

3. IEC No. & Date

Issuing Authority

:
:

4. If the registration is required as a manufacturer exporter :

S S I Registration / Industrial License / IEM No.
Issuing Authority

Other (specify)

Date :

5. Details of Directors/Partners/Proprietor/Karta to be given in the following manner :

Name

Father's Name

Residential Address

Telephone

6. EH/TH/STH/SSTH Certificate No. & Date :

Valid Upto :
7. Name of export product(s) for
which registration is required (please
attach separate sheet if required)

8. Export Turnover for the last Three Years :

9. I/We hereby solemnly declare that the above stated information is true and correct. We undertake without
any reservation to :
a. abide by the terms of the registration certificate granted to us on all our exports.
b. agree to abide by any code of conduct that may be prescribed.
c. agree to abide by export floor price condition that may be stipulated by Registering Authority.
d. furnish without fail quarterly returns of exports including nil returns to the registering authority by 15th day
of the months following the quarter
10. We further understand that our registration is liable to be canceled in the event of breach of any of the
undertakings mentioned above.
Yours faithfully

(Signature)
Name :
Address :
Designation :
Tele No.
Place :

Date :

Fax No.

ph a r m e xcil

PHARMACEUTICALS EXPORT PROMOTION COUNCIL OF INDIA

(Setup by Ministry of Commerce & Industry, Govt. of India)
Regd. / Head Office : 101, Aditya Trade Centre, Ameerpet, Hyderabad - 500 038.Tel No. 23735462, 23735466, Fax : 23735464

REGISTRATION CUM MEMBERSHIP CERTIFICATE

PART - I
(To be filled in by the applicant)

PART - II
(To be filled in by the Registering Authority)

1.

Name and Address of the applicant ................................

This is to certify that M/s.....................................................

..................................................................................

.........................................................................................

2.

IEC Number...................................................................

3.

Pan Number...................................................................

4.

Address of the

.........................................................................................
is registered with us.

(i) Head Office :............................................................

Other details as per our records are as under :

.........................................................................

(i) Description of goods for which registered

(ii) Registered Office :..................................................

.....................................................................................................

...................................................................................

.....................................................................................................

(iii) Branch Office :.........................................................

...................................................................................
(iv) Factory :.........................................................

(ii) Registration number......................................................

(iii) Manufacturer exporter or Merchant exporter

5.

Year of establishment :..................................................

.....................................................................................................

6.

Description of export product(s for which registration is

(iv) Name(s) of Proprietor / Partner (s)

sought.................................................................................
7.

Whether registration is required as Merchant exporter

or Manufacturer exporter...............................................
...................................................................................

8.

Name of the Proprietor / Partner / Directors / Managing

Director (s) Karta ....................................................

.........................................................................................
.........................................................................................
.........................................................................................

Director.......................................................................
.............................................................................................
I/We hereby delcare that the above information is correct to the
best of my / our knowledge and belief. I/We undertake to abide
by the conditions, subject to which registration / membership is
granted.

This certificate is issued subject to the conditions laid down in

the relevant scheme of registration of this Council.

(Signature) ........................................................

Name....................................................................................................

Seal

Name in Block Letters .......................................

Designation ......................................................
Residential Address ..........................................

Signature.........................................................................................

Designation.........................................................................................
Seal.......................................................................................................

Place :..........................

Valid / upto......................................................................

Date :...........................

Date of issue........................................................................................

1. This Certificate is valid for five years unless revoked/ amended earlier, subject to the condition that membership with the Council is renewed from year to year.
2. One of the conditions of the Certificate is that the Registered Exporter is required to send to this Council a quarterly statement of his exports, failing which the certificate could be
cancelled.
3. This Certificate covers all the product groups covered by this Council.

CONDITIONS

AMENDMENTS

ph a r m e xcil

PHARMACEUTICALS EXPORT PROMOTION COUNCIL OF INDIA

(Setup by Ministry of Commerce & Industry, Govt. of India)
Regd. / Head Office : 101, Aditya Trade Centre, Ameerpet, Hyderabad - 500 038.Tel No. 23735462, 23735466, Fax : 23735464

REGISTRATION CUM MEMBERSHIP CERTIFICATE

PART - I
(To be filled in by the applicant)

PART - II
(To be filled in by the Registering Authority)

1.

Name and Address of the applicant ................................

This is to certify that M/s.....................................................

..................................................................................

.........................................................................................

2.

IEC Number...................................................................

3.

Pan Number...................................................................

4.

Address of the

.........................................................................................
is registered with us.

(i) Head Office :............................................................

Other details as per our records are as under :

.........................................................................

(i) Description of goods for which registered

(ii) Registered Office :..................................................

.....................................................................................................

...................................................................................

.....................................................................................................

(iii) Branch Office :.........................................................

...................................................................................
(iv) Factory :.........................................................

(ii) Registration number......................................................

(iii) Manufacturer exporter or Merchant exporter

5.

Year of establishment :..................................................

.....................................................................................................

6.

Description of export product(s for which registration is

(iv) Name(s) of Proprietor / Partner (s)

sought.................................................................................
7.

Whether registration is required as Merchant exporter

or Manufacturer exporter...............................................
...................................................................................

8.

Name of the Proprietor / Partner / Directors / Managing

Director (s) Karta ....................................................

.........................................................................................
.........................................................................................
.........................................................................................

Director.......................................................................
.............................................................................................
I/We hereby delcare that the above information is correct to the
best of my / our knowledge and belief. I/We undertake to abide
by the conditions, subject to which registration / membership is
granted.

This certificate is issued subject to the conditions laid down in

the relevant scheme of registration of this Council.

(Signature) ........................................................

Name....................................................................................................

Seal

Name in Block Letters .......................................

Designation ......................................................
Residential Address ..........................................

Signature.........................................................................................

Designation.........................................................................................
Seal.......................................................................................................

Place :..........................

Valid / upto......................................................................

Date :...........................

Date of issue........................................................................................

1. This Certificate is valid for five years unless revoked/ amended earlier, subject to the condition that membership with the Council is renewed from year to year.
2. One of the conditions of the Certificate is that the Registered Exporter is required to send to this Council a quarterly statement of his exports, failing which the certificate could be
cancelled.
3. This Certificate covers all the product groups covered by this Council.

CONDITIONS

AMENDMENTS

ph a r m e xcil

PHARMACEUTICALS EXPORT PROMOTION COUNCIL OF INDIA

(Setup by Ministry of Commerce & Industry, Govt. of India)
Regd. / Head Office : 101, Aditya Trade Centre, Ameerpet, Hyderabad - 500 038.Tel No. 23735462, 23735466, Fax : 23735464

REGISTRATION CUM MEMBERSHIP CERTIFICATE

PART - I
(To be filled in by the applicant)

PART - II
(To be filled in by the Registering Authority)

1.

Name and Address of the applicant ................................

This is to certify that M/s.....................................................

..................................................................................

.........................................................................................

2.

IEC Number...................................................................

3.

Pan Number...................................................................

4.

Address of the

.........................................................................................
is registered with us.

(i) Head Office :............................................................

Other details as per our records are as under :

.........................................................................

(i) Description of goods for which registered

(ii) Registered Office :..................................................

.....................................................................................................

...................................................................................

.....................................................................................................

(iii) Branch Office :.........................................................

...................................................................................
(iv) Factory :.........................................................

(ii) Registration number......................................................

(iii) Manufacturer exporter or Merchant exporter

5.

Year of establishment :..................................................

.....................................................................................................

6.

Description of export product(s for which registration is

(iv) Name(s) of Proprietor / Partner (s)

sought.................................................................................
7.

Whether registration is required as Merchant exporter

or Manufacturer exporter...............................................
...................................................................................

8.

Name of the Proprietor / Partner / Directors / Managing

Director (s) Karta ....................................................

.........................................................................................
.........................................................................................
.........................................................................................

Director.......................................................................
.............................................................................................
I/We hereby delcare that the above information is correct to the
best of my / our knowledge and belief. I/We undertake to abide
by the conditions, subject to which registration / membership is
granted.

This certificate is issued subject to the conditions laid down in

the relevant scheme of registration of this Council.

(Signature) ........................................................

Name....................................................................................................

Seal

Name in Block Letters .......................................

Designation ......................................................
Residential Address ..........................................

Signature.........................................................................................

Designation.........................................................................................
Seal.......................................................................................................

Place :..........................

Valid / upto......................................................................

Date :...........................

Date of issue........................................................................................

1. This Certificate is valid for five years unless revoked/ amended earlier, subject to the condition that membership with the Council is renewed from year to year.
2. One of the conditions of the Certificate is that the Registered Exporter is required to send to this Council a quarterly statement of his exports, failing which the certificate could be
cancelled.
3. This Certificate covers all the product groups covered by this Council.

CONDITIONS

AMENDMENTS