Official Application • Regulation 20 CBLR • Statutory Enrollment

Membership Application Portal

Complete the official registration form to apply for Pipavav Customs Brokers Association membership. Please provide accurate firm, license, and branch details.

Online Registration Form

MEMBERSHIP APPLY

Fields marked with an asterisk (*) are mandatory.

Secure Form

Office Type *

Main Office

Branch Office

Company Name *

Company Type *

Authorized Person *

Authorized Person Designation *

Address *

City *

Is correspondence address the same as registered address?

Correspondence Address

Correspondence City

Email ID *

Alt Email Id 1

Alt Email Id 2

Mobile No. *

Alt Mobile No 1

Alt Mobile No 2

Tel No *

Alt Tel No 1

Alt Tel No 2

Website URL

Employee with pass

Employee without pass

Total Emp

Old CHA No

Old CHA Date

New CHA No *

New CHA Date *

GST No *

Parent Custom House *

Member of Association

Agent No

Username *

Password *

Agent Service Type

Company Logo *

The file size must not exceed 1MB (Accepted: PNG, JPG, JPEG)

Branch Office Details

Parent & Branch Office Particulars

Regd Office Pin / Zip Code

Belongs to city

Parent Main Custom House

Parent Main Type

Main Contact Details

Main Contact Mobile

Main Contact Email ID

Main Contact Address

Parent City

Zip Code

Tel No

Alt Tel No 1

Mobile No

Alt Mobile No 1