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MUNDRA CUSTOM BROKER ASSOCIATION

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Office Type

Main Office Branch Office

Company Name

Company Type

Authorized Person

Authorized Person Designation

Address

City

Is correspondence address the same as registered address?

Correspondence Address

Correspondence City

Email ID

Alt Email Id 1

Alt Email Id 2

Mobile No.

Alt Mobile No 1

Alt Mobile No 2

Tel No

Alt Tel No 1

Alt Tel No 2

Website URL

Employee with pass

Employee without pass

Total Emp

Old CHA No

Old CHA Date

New CHA No

New CHA Date

Custom House

Ahmedabad

Aurangabad

Bangalore

Chennai

Cochin

Coimbatore

Delhi

GANDHIDHAM

Goa

Hapur

Hyderabad

Indore

Jamnagar

Kakinada

Kandla

Kanpur

KOCHI

Kolkatta

LUCKNOW

Ludhiana

Mangalore

MUDRA

Mumbai

NAGPUR

Nagpur

Nashik

Noida

Patna

Pune

Rajasthan

SURAT

Thiruvanthapuram

Tuticorin

Visakhapatnam

Parent Custom House

Member of Association

GST No

Agent No

Username

Password

Agent Service Type

Company Logo

Regd Office Pin / Zip Code

Belongs to city

Parent Main Custom House

Parent Main Type

Main Contact Details

Main Contact Mobile

Main Contact Email ID

Main Contact Address

Parent City

Zip Code

Tel No

Alt Tel No 1

Mobile No

Alt Mobile No 1

Please Upload Licence copy

The file size must not exceed 1MB

Please Upload Authorised Person Photo

The file size must not exceed 1MB

Please Upload Aadhar card of license owner

The file size must not exceed 1MB

Please Upload Address proof

The file size must not exceed 1MB

Please Upload GST Copy

The file size must not exceed 1MB

Please Upload F Card Copy

The file size must not exceed 1MB

Please Upload Pan card

The file size must not exceed 1MB

Please Upload Licence copy

The file size must not exceed 1MB

Please Upload Authorised Person Photo

The file size must not exceed 1MB

Please Upload Aadhar card of license owner

The file size must not exceed 1MB

Please Upload Pan card

The file size must not exceed 1MB

Please Upload GST Copy

The file size must not exceed 1MB

Please Upload F Card Copy

The file size must not exceed 1MB

Please Upload Endorsement letter

The file size must not exceed 1MB

Please Upload Aadhar Card of Authorised person

The file size must not exceed 1MB

Please Upload Pan card of authorised person

The file size must not exceed 1MB

Please Upload Local Address Proof

The file size must not exceed 1MB

Please Upload Customs Pass of POA person

The file size must not exceed 1MB

Please Upload Copy of POA for branch office

The file size must not exceed 1MB

Is Accrediated Membership required?

No Yes

Name of Accrediated member

Accrediated member Designation

Mobile No of Accrediated member

Photo of Accrediated member

Name of Accrediated member 1

Accrediated member Designation 1

Mobile No of Accrediated member 1

Photo of Accrediated member 1

I agree to MUNDRA CUSTOM BROKER ASSOCIATION Terms & Condition.

I have no objection to receive any sms / email/ Whatsapp from the association for my information purpose

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