ISGF Membership Application Form : 2015 Office: India Smart Grid Forum, c/o Central Board of Irrigation and Power, CBIP Building, Malcha Marg, Chanakyapuri, New Delhi 110021 Email: Poonam.chadha@indiasmartgrid.org | Website: www.indiasmartgrid.org Membership Number (to be allotted by ISGF): A Member Details Name: Address: State: Postcode: Country: Telephone: Mobile: Email: Pan Number: B Prime Nominee (person representing the Member in ISGF) Name: Designation: Work Location: Address: State: Postcode: Country: Telephone: Mobile: Email: Please specify the preferred address for correspondence Profile/Resume of the Member’s Prime Nominee may please be attached Alternate Nominees and their contact Information (please furnish name, mobile & email) 1. Page 1 2. C Member’s Business Area of Business - Government/Utility/Policy&Regulation/Research/Academia/Industry Association/Media&Publication/ Industry (Communication, EPC, IT (OEM & SI), Consulting, Engineering, Metering, Other Technology Providers)/Individual/Other Brief Description Number of Years in Business (Optional): Number of Employees (Optional): Turnover: Year (Optional) Currency: Amount: Brief on Operations in India: D Membership Category Category: Government/Regular (Utility/Industry) / Associate/Individual/International/Honorary - Please refer details at the bottom of this Form E Payment Details (Payment to be made after membership is approved by Board of Governors of ISGF):Amount Cheque/DD/Wire Transfer Reference Number Cheque / DD drawn in favour of: India Smart Grid Forum F Choice of Working Groups WG Representative Name Mobile Email 1. 2. 3. .. .. Page 2 Profile/Resume of the Member’s Representatives in each WG may please be attached G Declaration We/I declare that the statements made on this form are true to the best of our/my knowledge and belief. I understand that the forum membership is voluntary. I have read the byelaws and MoA of Forum. We/I agree to comply with the Bye-laws and Rules of Conduct of the ISGF and understand that this is a commitment to behave ethically within our profession. We/I will do my best to promote the interests of the ISGF. I/We further declare that the Membership Contribution paid by us to ISGF shall form part of the Corpus. Signature: Date dd / mm / yyyy Category of Members and Contributions: • Government Members: enjoy voting rights; no membership contribution • Utilities (power utilities in Generation/Transmission/Distribution including Central / State Utility / PSU / Power Dept./ Private Utilities / Private Franchise Operators) : Full voting rights, representation in all Working Groups • Rs.10 Lakhs life time Contribution to the Corpus; 50% discount for Utilities from North East and Hills States; can be paid in one instalment or in maximum 5 equal annual instalments. • Industry: Contributions to the Corpus and Annual Contributions will be tiered on the basis of their Annual Global Revenue: • Above Rs.100 Crores: Rs.5 Lakhs Joining Contribution to the Corpus and Rs.1 Lakh Annual Contribution • Between Rs.20-100 Crores: Rs.3 Lakhs Joining Contribution to the Corpus and Rs.50,000 Annual Contribution • Below Rs.20 Crores: Rs.1 Lakhs Joining Contribution to the Corpus and Rs.50,000/- Annual Contribution • Full voting rights. Representation in all Working Groups. • Associate Members: Non-Profit/Educational & Research entities – no contribution; no voting rights; by invitation for a period of 2 years by BoG, renewable by decision of BoG. These entities will be selected by the BoG. • Individual Members: Rs.50,000/- as Joining Contribution to the Corpus – for eminent persons by invitation; voting right and representation in all Working Groups; annual contribution Rs.5000/• Honorary Members: Distinguished Personalities from different walks of life who could contribute to ISGF’s missions & objectives – by invitation of BoG only. No contribution, no voting right. • International Members: Entities having no presence in India; more as Observers; Rs.5 Lakhs or equivalent amount in foreign currency according to prevailing exchange rates as Joining Contribution to the Corpus. Full voting rights. Representation in all Working Groups. Annual Contributions: Rs.1 Lakh or equivalent amount in foreign currency according to prevailing exchange rates. Page 3 First Contribution to the Corpus is for the first 12 months; there after members will pay Contribution towards Annual Expenses as applicable for each calendar year