Membership card№ 35-	
Year of entrance       	

FORM
member of the Belarusian Chamber of Commerce and Industry

1.	Title in English	
		
2.	Country: 	
3.	Post address:   		
		
	Phone (	 ) 	 Fax (	) 	
	E-mail 		Web-site 	
4.	Date of establishment  	
5.	Field of activity:      industry                  trade                 services                  etc
6.		Property:                              state              private
7.	Account  #	  Bank 	
8.	Number of employees 	Year’s production volume (in USD)  	
	Export (in USD)   	 Import (in USD)   	
9	Head of the company (Name, Position) 		
10. Language:  English,  Russian,  etc: 	
11. Countries of export:	
12. Countries of import:	
13.	 Everyday activities (description): 	

		

Date " 	 " 	 20__  г.

Head of the company 	
Stamp