Startup Membership Application Form

Institution/Organization/Startup Name *

Address of Establishment *

Establishment's Contact Number *

Name of Founder/Director/Owner *

Designation *

Contact Number of Founder/Director/Owner *

Designation of Authorized Signatory *

Name of Authorized signatory/KMP/Contact Person *

Contact Number of Authorized Person *

Date of Establishment *

Email *

PAN

Registration Number

Describe Your Business Acitivities

Website / URL

Declaration

We, the undersigned, hereby apply for institutional/organizational/startup/entrepreneur membership of Kotik Foundation. We affirm that the information provided in this form is accurate to the best of our knowledge. By becoming an institutional member, we agree to support and promote the objectives and activities of the Kotik Foundation and actively participate in its programs and initiatives. Also We hereby agree to all terms and conditions related to membership in Kotik Foundation.