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Application Form


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INDONESIAN CHAMBER OF COMMERCE, VIETNAM
Ho Chi Minh City :
The Imperial Business CentreFloor 12, Petro Vietnam Building, 1 Le Duan StreetDistrict 1, Hochininh City Vietnam
Telp +84.8.5404.6868 ext 196Fax +84.8.5404.6969 ext 196
Email: info@indochamvn.com
Web: http://www.indochamvn.com/
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MEMBERSHIP APPLICATION FORM

MEMBERSHIP 2009: 1st January – 31st December

Membership Category
Corporate:
(1). Ordinary Coporate
(2) Ordinary Individual
(3) Associate Coporate
(4) Associate Individual
(5) Honorary

Please describe your links to Indonesia (please check all categories that are applicable)
O Indonesian citizen
O Lived in Indonesia for … years
O Works for an Indonesian company, or for a Vietnamese enterprise whose shareholding (equity) is owned by an Indonesian company/individual
O Works for the Indonesian Government
O Indonesian clients/business partners

Other
(please specify below)
………………………………………………………………………………………………………

State/Territory in which you have a principle link
O INA O Vn Other Please Specified :…………………………..

COMPANY INFO

Company Name :........…………………………………..
Company Address : …....………………………………..
Email Address : …...........………………………………..
Company Telephone :
Fax:
Company Website : …....………………………………..

Investment Type
O 100% Foreign
O wned0 BCC Partner (foreign)
O Representative office
O Vietnamese Company0 Joint Venture Company
O BCC Partner (Vietnamese)
O Government/Embassy
O Foreign Contractor
Other
(please provide details below) :…………………………………………………

Business Activity
O Government0 Construction/Property0 Education0 Retail0 Infrastructure
O Manufacturing – Other
O Banking and Finance
O Hospitality0 Mining0 Manufacturing – Industrial
O Services (please specify eg legal)
…………………………………………………
O Other (please provide details below)
………………………………………………….


PERSONAL DETAILS
Mr/Mrs/Miss/Ms/Dr : …………………………………………..
Title: …………………...............................................................
Nationality : …………………………………………....................
Date of Birth : …………………………………………..................
Residential Address : ………………………………………….....
........................................................
Residential Tel :
Mobile:
Residential E-mail : ………………………………………….
Spouse/Defacto’s name : ………………………………………….
Nationality : ………………………………………….
Date of Birth : ………………………………………….
Telephone/ Mobile :
Fax:
Residential E-mail : …………………………………………

Company Profile
Please provide information about your business activities in Vietnam.
Among other things, this information will be used by IndoCham to help us understand your business interests and to facilitate dialogue and referrals among like – minded business and industry.

This information will also be utilised in the IndoCham Membership Directories.
























Declaration: I agree to be bound by the Charter and rules of the Indonesian Chamber of Commerce Vietnam as may be in effect from time to time.

Signed: ____________________________________
Date: ___________________________

Note: Please send your corporate profile with two nominees’ passport photos
to info@indochamvn.com in HCMC for our directory and website update.