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1. BUSINESS INFORMATION

Primary Contact Person

(Working Directors, Senior Managers, Artisans and those Performing work of Artisans)
(All Administrative, Sales, Technical and Non-technical Staff)

2. DETAILS OF DIRECTORS/OWNERS

Director/Owner 1

Director/Owner 2

Director/Owner 3

3. AREAS OF SPECIALIZATION

4. EQUIPMENT

Details of Key Plant Utilized (If insufficient space, please list separately)

SN BRAND, MODEL & YEAR OF MANUFACTURE

USE

QUANTITY

5. INDUSTRY CLUSTER AND ECOSYSTEM

5. ELECTRONIC COMMUNICATION

By signing this membership application form, you have hereby certified that the above mentioned details are true to the best of your knowledge and the Directors/Owners of the member company bind themselved jointly and severally for all debts which the member company may at anytime owe to CIPPON and that should the member company resign, will give three CIPPON (3) months written notification and ensure that all arrear subscription are paid in full. You agree to abide by the Code of Ethics as embodied in the CIPPON Code of Conduct and Ethic and agree to the collection of information and it`s use as described on page 7. You further agree to receive notices from CIPPON from time to time. I I the undersigned hereby state that i am authorised to conclude this agreement. I further agree to abide by the CIPPON code of ethics and to fulfill the terms and conditions as laid out herein.