THE KENYA NATIONAL CHAMBER OF COMMERCE AND INDUSTRY
MOMBASA BRANCH
P. O. Box 90271, Mombasa. Tel +254 230934/ 316535 Tel/Fax: 230928
APPLICATION FOR MEMBERSHIP
I/We desire to be admitted to membership of Kenya National Chamber of Commerce and Industry upon the items of, and subject in all respects to, the Constitution and Rules of National Chamber.
Name of Business (or Individual) _________________________________
Place of Business (Street and Location) ____________________________
P. O. Box ________________________________________ Town: ____________________________________________
District:__________________________________________ Telephone: ________________________________________
Fax:_____________________________________________ E-mail: ___________________________________________
MEMBERSHIP INFORMATION
Business Office: Branch: ____________Regional: _________________Headquarter: ____________________Country of incorporation (if foreign): ______________________________Year _________________________Number of employees: full time _________________part time _____________Seasonal ___________Full Names of Proprietor, Partners, Principals, Directors or Officers (as applicable) & Nationalities:
Kenyan Executives: ___________________________________________ Title: ___________________________________
Others: ______________________________________________________________________________________________
Please indicate the name of the person to be listed as your firm’s Chamber representative:
Name: _______________________________________________ Title: __________________________________________
Please give a specific description, or brand name of your products (manufactured/produced/distributed/retailed or imported) or service(s) to allow our Trade Officer refer inquiries to you.
Products Manufactured/Produced: ________________________________________________________________________
____________________________________________________________________________________________________
Products Exported: ____________________________________________________________________________________
Products Imported: ____________________________________________________________________________________
Services Offered: ______________________________________________________________________________________
Retailer/Distributor of: _________________________________________________________________________________
Membership fees (See applicable rates annexed)
I/We enclosed Cheque/Money order No. ____________ in the amount of Kshs, ___________ Being Kshs. ______________ in respect of Entrance Fee for the appropriate Membership; and Kshs. ______________ in respect of Annual Subscription Fees, paid in advance.
Cheque drawn in favor of “Kenya National Chamber of Commerce & Industry”
SIGNATURE ____________________________________________ OFFICIAL STAMP