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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
*
Date of Birth
*
Address
*
Telephone No.
Mobile No.
*
Fax No.
Email
*
Website
Additional details
Details of any Awards, Prizes, Recognitions received by the nominee in the past
*
Photographs of the work done
*
Self Nominated
Yes
No
*
Mention the source of information about the PURASKAR
*
If Nomination is Proposed, Details of Proposer
Name of the Proposer
Address
Telephone No.
Mobile No.
Fax No.
Email
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
Surrounding
Individuals
In what way could the work be regarded as
Outstanding
Innovative
Prospects of continuity and potential for future development
Financial position of the enerprise
(Please attach Balance Sheet Current year and preceding two years)
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