Start UP; Stand UP India Awards

Friday, 17th June, Radisson BLU, Ranchi, Jharkhand

AWARDS CATEGORY / NOMINATION FORM

Last date for submission of entries – 1st June 2016

  1. Basic Information

a)

Name of the Company
Constitution of the Company (Proprietorship/Partnership/Private Limited/ Limited/ LLP)
Address
Phone / Fax
Email ID

b)Details of the Chief Executive Officer/ Managing Director/ Proprietor of the Company:

Name / Email ID / Sex
Landline No. / Mobile No. / Designation

c)Segment(Please tick as applicable)

Services Manufacturing Trading

d)Number of years in operation <3 3-5 6-10 >10

e)Total Number of Employees (Permanent + Casual workers)

f)Is the Company a Member of ASSOCHAM? YES NO

g)Is the Company listed on stock exchanges? YES NO

h)Is the Company rated? YES NO. If yes, Please specify the Rating and the Rating Agency? (Valid & not older than January-2016)

i)The number of product or process patents in the Company NIL 1-3 4-6 >6

  1. Financial Performance

a) FY 2015 – 16 FY 2014 – 15 FY 2013-14

Turnover (Crores)
PAT *(Crores )
Net Worth (Crores )
Current Total Banking Limits (Working Capital + Term Loans)( as on 31st March 2016)

b)Ratios:

c)Are the above financial statements audited? YES NO

d)Forex revenues as a percentage of turnover?

<1% 1%-10% 11%-30% 31%-60% >60%

e)What is the percentage of Imports among total purchases?

<1% 1%-10% 11%-30% 31%-60% >60%

  1. Award Category (Please tick as applicable)

Start up of the Year
Campus Start upof the Year
Lean Start up of the Year
Tech Business of the Year
Social Enterprise of the Year
Green Business of the Year
Fair Business Practices of the Year
Service Business of the Year
Stand Up Women of the Year
Most Promising Brand
 Young Entrepreneur of the Year
Product Business of the Year

Brief Description Explain how your nominee has made exceptional achievements and championed skills: (Maximum word limit of 1000 Characters)

Objective:

Target Group:

Geographical Reach

Please specify reach within India:

Please specify reach outside India:

When did it become operational?

Five points that make the Project/ Approach innovative:

Five key achievements of the Project / Approach:

Five key challenges faced while implementing the Project / Approach and how they were overcome:

Five points that make the Project / Approach replicable:

Five points to elaborate on the scalability of the Project / Approach:

Award Processing Charges / INR 10,000/-

*All nominations must reach ASSOCHAM by email at the email ID of

* Last Date for Nomination is 1st June 2016

Documents to be enclosed:

  1. Brief write-up of maximum 1000 words outlining the activities undertaken towards contribution to the field of AWARD applied for. In case you are applying for more than one AWARD please enclose a separate write-up and appendix for each category Award.
  2. Photo Album as an appendix to the write-up
  3. Testimonials supporting your stake
  4. The brochure / printout highlighting the innovation features.

Points to be noted:

  • You can enclose separate sheets, if the aforesaid rows stand out to be insufficient
  • All the documents, write-up, extra sheets etc needs to be signed and sealed by the Director/ CEO of the organization without which the documents would be considered invalid
  • Award Nomination fee per category is Rs. 10,000/- which includes two delegates participation from the concerned organization; on a complimentary basis
  • All the Demand Drafts should be drawn in favor of “ASSOCHAM ” payable at New Delhi or payment can be made online through the payment gateway
  • Scan Copy of DD required to be uploaded in the payment form to complete the registration
  • Nomination fee would not be accepted in cash or cheque or any other form apart from the one mentioned above
  • The decision of the jury panel would be final and binding in all respect
  • In case of any dispute the matter shall be dealt under Delhi jurisdiction only
  • Separate form needs to be filled for each category of awards applied

ASSOCHAM Bank Transfer Detail

Name of Account Holder and Address / The Associated Chambers of Commerce and Industry of India
5, Sardar Patel Marg, Chankyapuri
New Delhi - 110 021 India
Bank Name / Punjab National Bank
Bank Current Account Number / 1736000100149002
Bank Address / Sardar patel Marg Chanakyapuri,
New Delhi- 110 021 India
Branch code ( If any) / 173600
MICR Code / 110024100
Indian Financial System Code- (IFSC Code / PUNB0173600
National Electronic Fund Transfer Code- (NEFT Code) (if any) / PUNB0173600

For Participation & Partnership Opportunities Please Contact

Bharat Kumar Jaiswal
Regional Director

Mobile: +91 9971047550

Email: