Companies/Institutions

The Western India Automobile Association
76, Veer Nariman Road, Churchgate, Mumbai 400 020

MEMBERSHIP FORM
(FOR COMPANIES/INSTITUTIONS)

Name of Company / Institution _________________________________________________________
(In block letters)

Office Address ______________________________________________________________________

___________________________________________________Telephone No. ___________________

Name of Nominated Representative _____________________________________________________
(For voting purpose)

Specimen Signature of Nominated Representative _________________________________________

Details of Vehicles to be registered for Service

Registration Number of Vehicle	Make	Year of Manufacture
1.
2.
3.
4.

* If there are more vehicles attach details in a separate sheet.

We agree to be bound by all rules of the Association and the alterations made therein from time to time.

Paid by cash / cheque No._______________dated _____________ an amount of Rs._____________

Note: 1. Applicants can register for service, only vehicles owned by them and their spouses. They can
also include one vehicle given to them for use by the company

Note: 2. Applicants must produce Registration/Taxation Certificate of the vehicles to be registered for service.

Proposed by ______________________________________________ Membership No.____________

Seconded by ______________________________________________ Membership No.____________

Click here for Individual Membership Form