SOCIETY FOR CORPORATE SOCIAL RESPONSIBILITY – SRI LANKA

(SCSR – SL)

Mission

“To offer Sri Lanka Responsible Economic Leadership”

APPLICATION FOR CORPORATE MEMBERSHIP

I/We hereby apply to be enrolled as a member of the (SCSR – SL) and I/We agree to abide by the conditions and rules of the (SCSR – SL) from time to time in force.

I/We enclose cheque for Rs………….covering Membership Subscription and Enrolment fee April 2004/March 2005. Cheque to be drawn in favour of Society for Corporate Social Responsibility – Sri Lanka

Category of Membership
Corporate Member: - Annual Membership fee Rs. 5000/-

Individual Ordinary Members: - Annual Membership fee Rs. 2000/-

Individual Associate Members: - Annual Membership fee Rs. 1000/-

Students Full Time - Annual Membership fee Rs. 100/-

All sections must be filled

1. Name of Applicant (Corporate/Individual) : …………………………………………………

2. Category of Membership: …………………………………………………………………….

3. Address (Office) : ………..………………………………………………………………….

Address (Res.) : .…………………………………………………………………………..

4. Telephone : ……………………………. Fax: ……………………………….

E-mail : ………………………………… website :……………………………

5. Brief details of the organization (please attach any brochure if available)

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

6. Names of the Executive Board/Committee/ Head of Dept. (as applicable)

a) ……………………………………………

b) ……………………………………………

c) ……………………………………………

d) ……………………………………………

e) ……………………………………………

7. Date of Incorporation/Registration/Established (as applicable): ………………………………………………..

8. Registration No/Incorporation No::…………………………………………………………

9. Name of Accredited Representative: ………………………… Designation: ……………...

Representative Direct Contact No: …………………………….

Fax No. …………………………………

E-mail: …………………………………

10. Name of Alternative Representative:………………………Designation: …………………..

Contact No: …………………………….

Fax No. …………………………………

11. Auditors: ……………………………………… Bankers: ……………………….…………...

12. Names of Chambers or Associations of which the applicant is a member.

a) ………………………………………………………………………

b) ………………………………………………………………………

c) ……………………………………………………………………….

13. We confirm that our application for membership must be formally approved by the Executive Committee SCSR – SL before the applicant may become a member of the Society for Corporate Social Responsibility – Sri Lanka. The Exco will consider the application for membership and the applicant will be advised in writing of the outcome.

14. Authorized Signature: ……………………………… Date:…………………

(same as in 6 (a) above)

15. Committee Approval: ……………………………………..

Date : …………….………………………..

Completed Application Form and related reference documents please forward to,

Secretary, Society for Corporate Social Responsibility

NAC Secretariat, National Agribusiness Council, No 103/7, Galle Road, Colombo 3

and for any clarification. Phone 2323646, 4715767