APPLICATION FOR ABLE

Mail to: JCI INDIA, National Headquarter, 506, Windfall, Sahar Plaza, J.B Nagar, (Andheri East)
Mumbai-400059,
Ph: 022- 71117112 E-mail: busns@jciindia.in

Member

Non Member

Name of the Applicant

Zon
e

Affix
Would like to attend
?

your photo

South*
North*
Name of the
LOM/Institution
Membership ID(if member)

Date of Birth

Dates Since JCI member

Educational Qualification

Name of the Business

Your Profession

High position held in

JCII

Area you a Trainer ?.. if

Specify

Address
Pin

Sta
te

City
Phone (Bus) with
STD code

Phone (Res)

Mobile*

E-Mail :*

How often you check

e-mail

Web Site :

Other Information

What computer packages can you

handle?
Do you have branches ? If so where ?
Status of the Business : Family Owned /
Sole Proprietor / Partnership / Pvt.Ltd. /
Ltd.
Your designation in the business
What is your specific role in the business ?

How many people report to you

Managers
Supervisors
Admin staf

Technical
Staf

Marketing
staf

Support staf

What do you manufacture / trade or what service do you provide?

Any other

What percentage of your gross income is spent on marketing expenses

Less than 10%
10% to 20%
20% to 30%
How do you market your product.
Services C & F
Agent
Distribution
Any other (Specify)

Name three of your best clients:

What have you done to solve these problems ?

What is your final business ambition

Wholesaler

Retailer

More than 30%

Direct Selling

Name two major problems faced by your business

What are your business plans for the next five years ?

What are your economic goals?

1 year

5 year

10 year

What are your expectations from this workshop ?

Payment details
Demand Draft No.

Signature of Applicant

Date

Amount

Drawn on Bank name

Name and signature of LOM president

Important Note:

The application with Registration fee of Jaycees Rs.8000 + Service Tax 14.5% = Rs.9160/-