WEBC Registration Form

1

Name of Business

2

Name of Director (s)

First Name

Last Name

3

2nd Director (optional)

First Name

Last Name

4

Email

example@example.com

5

Mobile Contact

Please enter a valid phone number.

6

Is your Business a:

7

Is your business formally registered with Registration of Companies?

YESNO

8

Company Registration Number

9

Company Tax Identification Number

11

If you choose others on the above question, please indicate the nature of your Business.

12

Brief description about your business

13

Business operation since:

Date

14

Number of Employees:

Female

Male

15

Website

16

Mailing Address:

17

Physical Address:

18

Directors Skills Set:

19

Directors Qualification/ Profession:

20

Are you a Member of any Board?

YESNO

21

If your answer is Yes, what Organisation are you a Board Member in?

22

If your answer is No, are you interested to be recommended to any?

23

Payment Details as follows:

Membership Fees:

Joining Fee - $57.50

Annual Subscription - $57.50

Total Payment - $115.00

Bank details are as follows:

Bank: Westpac

Account Name: Fiji Commerce & Employers Federation

Account Number: 37194200

Narration: Your Business Name