For offline process, please download the form and send us on info@fpmeindia.com Download FormMerchant Exporter MemberAssociate MemberMerchant Exporter Member To the Director'FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS' Office No. 6, Ground Floor, Plot 1825, Lotus House, VT Marg, Near Liberty Cinema, Churchgate, Mumbai-400020, Maharashtra Dear Sir, Kindly enroll us as Merchant Exporter Member of FPME (FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS)'FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS'<br /> Office No. 6, Ground Floor, Plot 1825, Lotus House, VT Marg, Near Liberty Cinema, Churchgate, Mumbai-400020, Maharashtra<br /> <br /> Dear Sir,<br /> Kindly enroll us as Merchant Exporter Member of FPME (FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS)Field is required!Field is required!Your NameField is required!Field is required!Select StateAndaman and Nicobar IslandsAndhra PradeshArunachal PradeshAssamBiharChandigarhChhattisgarhDadar and Nagar HaveliDaman and DiuDelhiGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherry (Pondicherry)PunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalSelect StateField is required!Field is required!Postal Address:Field is required!Field is required!PincodeField is required!Field is required!CityField is required!Field is required!Telephone Number (With STD Code)Field is required!Field is required!Turnover in Rs.Upto 10 CroreUpto 20 CroreUpto 30 CroreUpto 40 CroreUpto 50 CroreField is required!Field is required!Pharmaceutical FormulationsBulk Drugs & Drug IntermediatesHerbal Products (including Ayurvedic, Homeopathic, Unani and Siddha Medicines)Biotech Products (including vaccines and recombinant products)Pharmaceutical Services (including R & D, Clinical Trials, Medical Transcripts)Healthcare Products (Including Surgicals, Diagnostics, Medical Devices etc)Others: Pls specifyField is required!Field is required!Other:Field is required!Field is required!Details of Directors/Partners/Proprietor/Karta to be given in the following manner :Director-1 / Proprietor / Partner Field is required!Field is required!Director-1 Telephone / Mobile / WhatsappField is required!Field is required!Director-1 Email Field is required!Field is required!Director-1 Designation Field is required!Field is required!Field is required!Field is required!Director-2 / Proprietor / PartnerField is required!Field is required!Director-2 Telephone / Mobile / WhatsappField is required!Field is required!Director-2 DesignationField is required!Field is required!Director-2 EmailField is required!Field is required!Details of Certificate No. & Validity:IEC No. (Firm)Field is required!Field is required!RCMC (Firm)Field is required!Field is required!GST No. (Firm)Field is required!Field is required!Wholesale/Retail DL No. (Firm) Field is required!Field is required!PAN No. (Firm)Field is required!Field is required!Please Attach above docs here (Documents are required for Approval of Membership)IEC, GST No. (Firm), PAN No. , DL No. (Please Do not add more than 5MB file.)Upload your documents...Field is required!Field is required!I/We hereby solemnly declare that the a) Above stated information is true and correct. We undertake without any reservation to : b) I / We are not engaged, directly or indirectly, into any manufacturing activity and agree to inform the Association in case of any change therein. We further understand that our registration is liable to be cancelled in the event of a breach of any of the undertakings mentioned above. Note: Membership number will only be granted after the Committee verifies all the information and confirms membership fees payment details furnish. A copy of your responses will be emailed to the address you provided.I/We hereby solemnly declare that the <br /> <br /> a) Above stated information is true and correct. We undertake without any reservation to :<br /> b) I / We are not engaged, directly or indirectly, into any manufacturing activity and agree to inform the Association in case of any change therein.<br /> <br /> We further understand that our registration is liable to be cancelled in the event of a breach of any of the undertakings mentioned above. <br /> <br /> Note: Membership number will only be granted after the Committee verifies all the information and confirms membership fees payment details furnish.<br /> A copy of your responses will be emailed to the address you provided.Field is required!Field is required!Bank Account DetailsBeneficiary Name: Federation Of Pharmaceutical And Allied Products Merchant Exporters Beneficiary Address: Office No. 6, Ground Floor, Plot 1825, Lotus House, Vt Marg, Near Liberty Cinema, Churchgate, Mumbai-20<strong>Beneficiary Name:</strong><br /> Federation Of Pharmaceutical And Allied Products Merchant Exporters<br /> <br /> <strong>Beneficiary Address:</strong><br /> Office No. 6, Ground Floor, Plot 1825, Lotus House, Vt Marg, Near Liberty Cinema, Churchgate, Mumbai-20Field is required!Field is required!Bank Name: Kotak Mahindra Bank Ltd. Branch Opera House IFSC Code KKBK0000666 Account No. 4612895863 Account Type Saving Account<strong>Bank Name:</strong><br /> Kotak Mahindra Bank Ltd.<br /> Branch Opera House<br /> IFSC Code KKBK0000666<br /> <br /> <strong>Account No.</strong><br /> 4612895863<br /> <br /> <strong>Account Type</strong><br /> Saving AccountField is required!Field is required!Payment Detail- select a option -ChequeNEFT/IMPSUPI- select a option -Field is required!Field is required!Transaction Detail (Cheque No. / UTR Code/ Transaction Ref. No.)Field is required!Field is required!Submit Associate Member To the Director'FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS' Office No. 6, Ground Floor, Plot 1825, Lotus House, VT Marg, Near Liberty Cinema, Churchgate, Mumbai-400020, Maharashtra Dear Sir, Kindly enroll us as Merchant Exporter Member of FPME (FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS)'FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS'<br /> Office No. 6, Ground Floor, Plot 1825, Lotus House, VT Marg, Near Liberty Cinema, Churchgate, Mumbai-400020, Maharashtra<br /> <br /> <strong>Dear Sir,</strong><br /> Kindly enroll us as Merchant Exporter Member of FPME (FEDERATION OF PHARMACEUTICAL AND ALLIED PRODUCTS MERCHANT EXPORTERS)Field is required!Field is required!Your NameField is required!Field is required!Select StateAndaman and Nicobar IslandsAndhra PradeshArunachal PradeshAssamBiharChandigarhChhattisgarhDadar and Nagar HaveliDaman and DiuDelhiGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherry (Pondicherry)PunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalSelect StateField is required!Field is required!Postal Address:Field is required!Field is required!PincodeField is required!Field is required!CityField is required!Field is required!Telephone Number (With STD Code)Field is required!Field is required!Pharmaceutical FormulationsBulk Drugs & Drug IntermediatesHerbal Products (including Ayurvedic, Homeopathic, Unani and Siddha Medicines)Biotech Products (including vaccines and recombinant products)Pharmaceutical Services (including R & D, Clinical Trials, Medical Transcripts)Healthcare Products (Including Surgicals, Diagnostics, Medical Devices etc)Others: Pls specifyField is required!Field is required!Other:Field is required!Field is required!Details of Directors/Partners/Proprietor/Karta to be given in the following manner :Director-1 / Proprietor / Partner Field is required!Field is required!Director-1 Telephone / Mobile / WhatsappField is required!Field is required!Director-1 Email Field is required!Field is required!Director-1 Designation Field is required!Field is required!Field is required!Field is required!Director-2 / Proprietor / PartnerField is required!Field is required!Director-2 Telephone / Mobile / WhatsappField is required!Field is required!Director-2 DesignationField is required!Field is required!Director-2 EmailField is required!Field is required!Details of Certificate No. & Validity:IEC No. (Firm)Field is required!Field is required!RCMC (Firm)Field is required!Field is required!GST No. (Firm)Field is required!Field is required!Wholesale/Retail DL No. (Firm) Field is required!Field is required!PAN No. (Firm)Field is required!Field is required!Please Attach above docs here (Documents are required for Approval of Membership)IEC, GST No. (Firm), PAN No. , DL No. (Please Do not add more than 5MB file.)Upload your documents...Field is required!Field is required!I/We hereby solemnly declare that the a) Above stated information is true and correct. We undertake without any reservation to : b) I / We are not engaged, directly or indirectly, into any manufacturing activity and agree to inform the Association in case of any change therein. We further understand that our registration is liable to be cancelled in the event of a breach of any of the undertakings mentioned above. Note: Membership number will only be granted after the Committee verifies all the information and confirms membership fees payment details furnish. A copy of your responses will be emailed to the address you provided.I/We hereby solemnly declare that the <br /> a) Above stated information is true and correct. We undertake without any reservation to :<br /> b) I / We are not engaged, directly or indirectly, into any manufacturing activity and agree to inform the Association in case of any change therein.<br /> <br /> We further understand that our registration is liable to be cancelled in the event of a breach of any of the undertakings mentioned above. <br /> <br /> Note: Membership number will only be granted after the Committee verifies all the information and confirms membership fees payment details furnish.<br /> A copy of your responses will be emailed to the address you provided.Field is required!Field is required!Bank Account DetailsBeneficiary Name: Federation Of Pharmaceutical And Allied Products Merchant Exporters Beneficiary Address: Office No. 6, Ground Floor, Plot 1825, Lotus House, Vt Marg, Near Liberty Cinema, Churchgate, Mumbai-20<strong>Beneficiary Name:</strong><br /> Federation Of Pharmaceutical And Allied Products Merchant Exporters<br /> <br /> <strong>Beneficiary Address:</strong><br /> Office No. 6, Ground Floor, Plot 1825, Lotus House, Vt Marg, Near Liberty Cinema, Churchgate, Mumbai-20Field is required!Field is required!Bank Name: Kotak Mahindra Bank Ltd. Branch Opera House IFSC Code KKBK0000666 Account No. 4612895863 Account Type Saving Account<strong>Bank Name:</strong><br /> Kotak Mahindra Bank Ltd.<br /> Branch Opera House<br /> IFSC Code KKBK0000666<br /> <br /> <strong>Account No.</strong><br /> 4612895863<br /> <br /> <strong>Account Type</strong><br /> Saving AccountField is required!Field is required!Payment Detail- select a option -ChequeNEFT/IMPSUPI- select a option -Field is required!Field is required!Transaction Detail (Cheque No. / UTR Code/ Transaction Ref. No.)Field is required!Field is required!Submit
