HWM Registration – Udaipur Chamber of Commerce & Industry

MEMBERSHIP APPLICATION FORM

(All fields are mandatory to fill)

1. Company details

Company Name*	State
Pin Code*	GSTIN Number*
CIN No*	UIN No*
Registered Address (This is the Communication Address )	Factory Address (This is the Communication Address )

2. Details of the occupier / owner*

Name*	Designation*
E: Mail*	Contact*
Office No.

3. Details of the contact person / authorized person

Name*	Designation*
Department*	E: Mail*
Office No*	Mobile No*

4. Details of the products manufactured with annual quantity

Description	Quantity /annum

5. Type of hazardous wastes generated by the facility with estimated annual quantity

Waste type/Description	Code/Category as per Sch-I of HWM/BWM/EWM Rules, 2016	Quantity / Annum (MT)/No.

6. Incineration Facility Required Yes No	7. Estimated/Actual Investment
8. Upload GST Certificate	9. Expected date for disposal of Hazardous waste
10. Please upload CA Certificate if turnover is less than 5 crores.	Turnover
11. Date of Commencement of Production	The production has not started yet

12. Status of EC/Consents/ Authorization *	Environmental Clearance (EC)	Consent To Establish (CTE)	Consent To Operate (CTO)	HWM Authorization
Applied	Yes No	Yes No	Yes No	Yes No
Obtained	Yes No	Yes No	Yes No	Yes No
On Hold (Give reason)
Upload (Any One)
Any other Remarks

*13. Upload Undertaking (Download Template) for New Memberships only**
14. Transaction Details of Fee Deposited Kindly deposit the fees in respective accounts mentioned against the fee type. Click here for Account Details
HWM Membership Fee (UCCI)		Upload the Screenshot/Cheque/DD
Trust Development Fee (UIWM&RC)		Upload the Screenshot/Cheque/DD
15. Application on Company Letterhead

*Kindly upload the copy of document(s) and incomplete forms will not be processed*

Declaration

It is hereby declared that the information submitted is true to the best of our knowledge and we will furnish any other information as and when required.

NOTE -
1. Please arrange to submit a copy of receipt for Security Deposit given to the site operator and your first month waste disposal details to UCCI.
2. The security Deposit will be refunded by the site operator at the time of your withdrawal of membership subject to compliance of point 1 above.
3. The Membership needs to be renewed annually on payment of prescribed fees to UCCI.
4. In case you are not able to deposit the mentioned quantity of waste to the operator then please submit necessary clarification regarding the same to UCCI.

Place