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Application For Membership: Industrial Waste Management Association

This document is an application form for membership to the Industrial Waste Management Association. It requests information about the applicant industry such as name, address, contact details, type of industry, products, scale, types and quantities of hazardous waste generated and stored, and whether the industry has a hazardous waste authorization. The form notes that documents like air/water consent and proof of payment must be attached for the application to be considered.

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52 views2 pages

Application For Membership: Industrial Waste Management Association

This document is an application form for membership to the Industrial Waste Management Association. It requests information about the applicant industry such as name, address, contact details, type of industry, products, scale, types and quantities of hazardous waste generated and stored, and whether the industry has a hazardous waste authorization. The form notes that documents like air/water consent and proof of payment must be attached for the application to be considered.

Uploaded by

BALAJI
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INDUSTRIAL WASTE MANAGEMENT ASSOCIATION

Application for Membership


1. Name of the Industry:
2. Consent Order No:
3. Address of the unit as per Consent order :

4. Address for Communication:

4. Telephone No:
5. Name of the Representative:
6. Designation of the Representative:
7. Email ID:

8. Type of Industry:
(Automobile / Pharmaceutical / Chemical / Textile /
Leather / Engineering / Any other)

9. Type of Product(s):

10. Category of Industry:


(Tick wherever applicable) Red Orange Green

11. Scale
1 of the Industry based on Annual
Turnover:
0 Large Medium Small Micro
(Tick
. wherever applicable) (≥25Cr) (≤25Cr)

12. Type of Hazardous Waste (HW) generated:


Sl. Category of HW Quantity
No. (as per Schedule I & Schedule II of HW Rules, 2008) (Tonnes /Annum)

1. Landfillable

2. Incinerable
13. Quantity of HW Stored:
Sl. Category of HW Quantity
No. (as per Schedule I & Schedule II of HW Rules, 2008) (Tonnes)

1. Landfillable

2. Incinerable

14. HW Authorization availability (Yes / No):


If ‘Yes’ Years of Validity:

Signature of the Representative Organization Stamp with Date

FOR IWMA USE ONLY

Approved and Admitted By

Signature of Secretary Signature of Chairman

Note:
Documents to be attached along with the Application Form –
1. A copy of Air and Water Consent obtained for the unit (valid as on date)
2. Cheque/Draft (as per the Membership Fee details) made in favour of “Industrial Waste Management
Association” payable at Chennai
3. Certificate of proof for Small Scale or Tiny industries.

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