Membership & Service Provider Application Form

General Information

Date of Birth:

Types of Services

Legal ConsultantTax ConsultantVAT ConsultantMember (Gold)Member (Silver)Member (Bronze)

Present Address:

Permanent Address:

Business Information

Trade License Registration Date:

Trade License Renewal Date:

NID/Passport/ Driving License Copy, Trade License Copy, TIN Copy, VAT Copy, Company Registration Certificate Copy

Emergency Contact

Lifetime Member (BDT 150,000)Gold Member (BDT 15000)Silver Member (BDT 10,000)Bronze Member (BDT 2,500)

Declaration

I hereby certify that the information provided in this form is complete, true, and correct to the best of my knowledge. I will abide by the rules and regulations of the Women Entrepreneurs Network for Development Association (WEND).