<p> BSCIC CERTIFICATIONS PVT. LTD. (Formerly BSC INTERNATIONAL CERTIFICATIONS CO.) REGISTRATION APPLICATION Please complete and return to BSCIC Applicant (Organisation) </p><p>Address</p><p>Telephone – Fax – </p><p>Email - Contact - </p><p>Registration Applied for </p><p>BSCIC Price Quotation Ref No. Date: Total Fee Payable Up to Certification Curr. : : Fee Payable For Each Surveillance Curr.: : Applicant’s Activities for Registration</p><p>If different Invoice/ Mail address</p><p>Application payment cheque/ Draft No. Amt. INR Address of other sites under Registration.</p><p>Target for Registration Assessment : Declaration: I/we have read and accept the BSCIC Contract Terms & Scheme for Registration Document No. B 018 (Latest version Please check at www.bsc-icc.com). I/we undertake to pay all costs required for the BSCIC Certifications Private Limited (hereinafter termed as BSCIC) Registration as agreed on BSCIC price Quotation duly agreed & stamped by me/us, irrespective of the eventual granting of a Certificate of Registration.</p><p>I/we undertake, in the event of being granted a Certificate of Registration, to comply in all respects with the Agreement (as the same may be amended from time to time).</p><p>I/we accept that, on being issued with a Certificate of Registration, the BSCIC Registered Logo, Accreditation Marks and any statement made in association with it will only be used in the manner described by BSCIC and as reasonably required by BSCIC.</p><p>I/we acknowledge that any and all rights pertaining to the use of the Registered Logo are the sole property of BSCIC.</p><p>I/we shall refrain in all countries from causing or assisting any person to do any of the things set out below:  Registering a symbol identical with or similar to the Registered Logo  Using for any purpose a symbol identical with or similar to the Registered Logo</p><p>Authorised Signatory (Please affix Company Stamp) Date</p><p>E mail : [email protected] www.bsc-icc.com B002 Rev.09, 07 Apr 2012 Page 1 of 1</p>