Membership Application Form

Membership Application Form

The Greater Tunapuna Chamber of Industry & Commerce Tel: +1-868-322-4482 | Email: gtchamberinfo@gmail.com
Any information given on this form will be regarded as current and will be treated with the strictest confidence. As the Applicant, it will be to your advantage to provide the necessary information adequately. The completion of this Application Form will in no way obligate the Chamber to GUARANTEE membership.
Contact Details
Name (Company or Individual):
Registered Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from previous)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Telephone
Please enter a valid phone number.
Mobile Telephone
Please enter a valid phone number.
Email
example@example.com
Website URL
Bankers
Branch

Company Representatives
Representative # 1
Full Name

PrefixFirst NameMiddle NameLast Name
Position
Expertise / Interest
Email
example@example.com
Direct Phone
Please enter a valid phone number.
Cellphone
Please enter a valid phone number.
Address (If Different from Company)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Representative # 2
Full Name

PrefixFirst NameMiddle NameLast Name
Position
Expertise / Interest
Email
example@example.com
Direct Phone
Please enter a valid phone number.
Cellphone
Please enter a valid phone number.
Address (If Different from Company)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Representative # 3
Full Name

PrefixFirst NameMiddle NameLast Name
Position
Expertise / Interest
Email
example@example.com
Direct Phone
Please enter a valid phone number.
Cellphone
Please enter a valid phone number.
Address (If Different from Company)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Other Information
Are you interested in joining the GTCIC Health Plan?

YesNo
Are you interested in serving on any GTCIC Committees?

YesNo
The following documents / items must be submitted along with this application form:
1. Certificate of Incorporation/Registration
2. Constitution or By-Laws
3. Audited Financial Statements (Past three years)
4. VAT registration (if applicable)
5. Bank Reference
File Upload*

Cancelof
Declaration of Applicant
Applicant Company Representative
Applicant Representative Signature

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Date

MonthDayYear
Date
Proposer’s Name

PrefixFirst NameMiddle NameLast Name
Company (must be a financial member of G.T.C.I.C
Proposer's Signature

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Date

MonthDayYear
Date
Seconder’s Name

PrefixFirst NameMiddle NameLast Name
Company (must be a financial member of G.T.C.I.C
Seconder's Signature

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Date

MonthDayYear
Date

Annual Fees
Notes:

*Individuals/Professionals will be categorized under Category E

*Value Added Tax is not Applicable

*Associate refers to a member outside the Tunapuna Region

*The membership committee and the Board will have the discretion to refuse membership
KINDLY MAKE CHEQUE(S) PAYABLE TO:
THE GREATER TUNAPUNA CHAMBER OF INDUSTRY & COMMERCE
Name of Bank: Scotia Bank (Tunapuna Branch)
Account Number: 00882-18
Transit Number: 42135
Account Type: Cheque FOR OFFICIAL USE ONLY
COMPANY REPRESENTATIVES
Procedure:

Upon receipt of the duly completed application form, it will be forwarded to the next Board of Directors Meeting for their consideration and approval. A letter of acceptance and invoice for membership fees, where applicable, will be issued and a membership package arranged.

For Official Use Only
Date Accepted

MonthDayYear
Date
Category
Type a question
Date Paid

MonthDayYear
Date
Method of Payment
Receipt Number
Should be Empty: