For official use

Toll Fee no. 1800111955 Membership : New 

MSME GLOBAL MART : Renewal 
Activation Date:
An exclusive B2B Web Portal for MSMEs Products
Membership Application Form

1. Name of Company* (Write in Block Letters)

M/s

2. Name of CEO/MD
Mr. / Ms. / Mrs.

3. Address*

STATE PIN
E-mail*
Website: www. Tel. No
Mobile No 0 Fax. No.
4. Whether MSME:(Pl.Tick)  Yes  No

5. Activities: (Pl.tick)  Manufacturer  Reseller  Service Provider

5. Category: (Pl.tick)  General  SC  ST  OBC  WOMEN

6. Product(s)* (Pl. add extra sheet if required)

1. 5. 9.
2. 6. 10.
3. 7. 11.
4. 8. 12.

7. Year of Establishment: _____________ Employment: __________ Turnover in Rs. __________

8. Certification (if any)  ISO  QS  BIS  Hallmark  Other _______________

9. Are you an Exporter (Pl.tick) If Yes, Countries exported to:

 Yes  No

10. Give brief background and details of your company (Attach separate sheet if necessary):

11. Attach up to five images of your products

12. DD/Cheque Details: (a) Name of Bank. (b) DD./Chq. No.

(c) Amount: (d) Dated: (e) Date of Application:
We accept all major credit/Debit cards and Net Banking
13. Signature with Company’s Seal &
Date of Application

I have read the terms and conditions on www.msmemart.com carefully and hereby accept them
unconditionally and shall abide by them. I/we also certify that I have not been ever blacklisted by NSIC in any
of its schemes.
(Paste/staple your Photo
and business card in this
space)

(Please fill the form and send it to):

The National Small Industries Corporation Ltd.
NSIC Bhawan, Okhla Industrial Estate, Phase III, New Delhi-110020
Ph: 91-11-26926275, 26927502, 1800111955(Toll free no) Fax: 91-11-26927160
Website: www.msmemart.com, E-mail: info@msmemart.com