Theme of the year - Women Integration, Skills and Entrepreneurship

24th Jankidevi Bajaj Puraskar 2016 Nomination Form

Please fill up the below form. (*) fields are mandatory.

  Personal details
Name of the Nominee *
Date of Birth *
Address *
Telephone No.  
Mobile No. *
Fax No.  
Email *
  Additional details
Details of any Awards, Prizes, Recognitions received by the nominee in the past *
Photographs of the work done *
Self Nominated
Mention the source of information about the PURASKAR *
  If Nomination is Proposed, Details of Proposer
Name of the Proposer
Telephone No.  
Mobile No.
Fax No.  
Upload Scanned Signature of Proposer
  Professional details
Nature of Business Activities done over the years *
How has the work made an impact on:
Rural Development & Entrepreneurship

In what way could the work be regarded as
Prospects of continuity and potential for future development
Financial position of the enerprise
(Please attach Balance Sheet Current year and preceding two years)