MEMBERSHIP APPLICATION FORM

I.

Date:____________________
II. Company Name: ____AGROSFERA-BM SRL__________________________________________
III. Mailing Address:
City Pirlita

Main Phone (0236) 64 555

Street (& no.)

Alternate Phone (0236) 64 386

Zip Code

MD 3641

Main FAX (0236) 64 555

County/District Ungheni

Alternate FAX

IDNO:

E-mail: agrosferabm@mail.ru

1003609002830

Web Page http://www.agrosfera-bm.md

Preferred method of communication: E-mail

Fax

Post

IV. Contacts
Chief Executive

Officer

Buzovoi Andrei
Phone 068007708

Fax: (0236) 64 555

E-mail: agrosferabm@mail.ru

EBA The EBA Contact is the person designated by the affiliated company to be the recipient of all EBA - related
correspondence and to assist the association in membership and activity-related issues.
Name: _______________________________________ (title)
_______________________________
Phone___________________; Fax: _______________________E-mail:
________________________
V. Type of business of the company (please check all that applies)

Electric/Electronics Computer Services Telecommunications Automotive&Suppliers

Medical Machinery/Tools Food/Beverages Tourism Financial Institutions
Consumer Goods Pharmaceuticals/Cosmetics Chemicals Agriculture Energy Legal
services Consulting (Field_______________________) Other (please
specify)_________________________
VI. Additional information:
Year of Registration in Moldova: 2000
Years of business activity in Moldova. 14
Total investment of your company in Moldova (MDL/Euro): cca. 10 mln MDL
Number of employees: Worldwide: ___________________ in Moldova: 145
Percentage of Business with EU___________ Percentage of EU Ownership___________________
VII. Type of Membership/Entrance fee (please choose the category that applies to you):

Entrance fee (for all) 200 Euro

Membership fee for Business this is the regular fee applied to each new member. Annual fee: 1200 Euro
General Sponsor this is the fee applied to General Sponsors. Annual fee: 5000 Euro
La p. 6 si 7 va rog sa coordonati cu d. Andrei, ca sa fie informatia veridica, caci eu nu am acces la asemenea
informatie

VIII. Please provide a up to 100 word introductory presentation of your company to be included in the EBA
newsletter and published on the EBA website:
Compania Agricola Agrosfera-BM SRLeste printre primele intreprinderi din Republica Moldova care a realizat cu
success Programul de privatizare. Fiind creata cu statut de persoana juridica in anul 2000, SRL Agrosfera-BM a
asociat 1410 proprietari de terenuri agricole, cu o suprafata totala de 2111 ha.
Domeniul specific de activitate il constituie producerea si prelucrarea culturilor cerealiere, porumbului, rapitei, florii
soarelui, producerea semintelor, conservarea legumelor si a mazarii. Deasemenea prestam servicii specializate pentru
agricultura. Agrosfera-BM deine ntietatea n raionul Ungheni, ocupnd i primele poziii n republica
la cultivarea griului, porumbului si florii soarelui.
IX. EBA Moldova engages in various different types of activities to serve its members. Please indicate which of these
activities are of most interest to you and feel free to make additional suggestions.

Business advocacy Events Networking Round tables/Conferences/seminars Publications

Other:
_________________________________________________________________________________________
Please note that all questions are mandatory! Only complete applications will be accepted.

IMPORTANT! Please read the following statement and sign it

I would like to ask for my personal/companys data to be listed in the European Business Association in Moldovas
database. I understand that only complete documentation the filled-in membership application form will be
processed for the Boards evaluation. The present application form, once approved by the EBA Board of Directors,
represents a binding agreement between the parties and I/my company become(s) a member of EBAas soon as I/my
company make(s) the payment of the membership fee.

.
Applicants signature and companys stamp