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JANKIDEVI BAJAJ PURASKAR FOR WOMAN RURAL ENTREPRENEUR 2016
Share Your
Ideas
24th Jankidevi Bajaj Puraskar 2016 Nomination Form
Please fill up the below form. (
*
) fields are mandatory.
Personal details
Name of the Nominee
*
Mandatory!
Date of Birth
*
Mandatory!
dd-mm-yyyy
Address
*
Mandatory!
Upto 250 characters allowed
Telephone No.
Please enter numbers only
Mobile No.
*
Only Digit and Must be 10!
Fax No.
Please enter numbers only
Email
*
Mandatory!
Invalid Email
Website
Additional details
Details of any Awards, Prizes, Recognitions received by the nominee in the past
*
Mandatory!
Upto 250 characters allowed
Photographs of the work done
*
Mandatory!
Only .jpg or .gif or .png files
Self Nominated
Yes
No
*
Mandatory!
Mention the source of information about the PURASKAR
*
Mandatory!
If Nomination is Proposed, Details of Proposer
Name of the Proposer
Address
Maximum 250 words allowed
Telephone No.
Please enter numbers only
Mobile No.
Only Digit and Must be 10!
Fax No.
Please enter numbers only
Email
Invalid Email
Upload Scanned Signature of Proposer
Only .jpg or .gif or .png files
Professional details
Nature of Business Activities done over the years
*
Mandatory!
Upto 250 characters allowed
How has the work made an impact on:
Rural Development & Entrepreneurship
Surrounding
Individuals
Upto 250 characters allowed
Upto 250 characters allowed
Upto 250 characters allowed
In what way could the work be regarded as
Outstanding
Innovative
Prospects of continuity and potential for future development
Upto 1000 characters allowed
Financial position of the enerprise
(Please attach Balance Sheet Current year and preceding two years)
Mandatory!
Only .doc or .docx or .pdf files
Mandatory!
Only .doc or .docx or .pdf files
Mandatory!
Only .doc or .docx or .pdf files
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