This form needs to be submitted online here by 23:59 hrs, 25 Jan, 2011. http://spreadsheets.google.com/viewform?formkey=dHM4SmswbHRsVVVSOEFtZ0x6enJrNnc6MQ

1. ‘Made in India Search’ Application Form
We would like to showcase inspiring and innovative enterprising Indians and enterprises at
“Enterprising India: Changing the Nation, Leading the World”- a TiE initiative on 4th & 5th March
2011.
The showcased enterprises and entrepreneurs would be diverse, dynamic and distinctive, and
they would open our eyes, engage our imagination and inspire us to aim higher and go further.
They can be for-profit or not-for-profit enterprises.
We would showcase three-four such enterprises across each of the following four areas and the
following enterprising Indians (the EI Co-Hosts) will introduce them:
KV Kamath– Inclusive Development
Ajay Piramal - Health is Wealth
Kishore Biyani - Serving the Indian Consumer
R. Gopalakrishnan - Education the Great Leveler
Jayprakash Gaur- Innovate to win (Desi Jugaad)
The nominated enterprises would be evaluated and selected by the Made in India Jury, whose
decision will be final.
< Legend:
[]- check box
() radio button
___- single line text field
All questions are mandatory >
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2. Your personal details
First Name:___________________
Last Name: ________________________
Gender: () Male () Female
Age: ___
Job Title and Role: __________________________
Your Enterprise/organization
Nomination type <dropdown- select one> Enterprise type <dropdown-select one>
Enterprising Individual For profit enterprise
Enterprising Group A social enterprise
Enterprising Ecosystem An enterprising act / movement
Chooses the Nomination category (ies) that best describes your enterprise's focus?
[] Inclusive Finance
[] Health is Wealth
[] Serving the Indian Consumer
[] Innovate or Die
[] Education the great leveler
[] Make things better, make better things
Other (please specify) __________________
Your contact information
Address:____________________________
Phone:________________
Mobile:______________________
Email:____________________
Tell us about yourself and what you do:
(This section is important, please take the time to answer the questions thoughtfully, with
enough detail to help us understand who you are and what you do. All responses are limited to
250 words except where noted.)
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3. What other achievements would you like to share?
Tell us about your enterprise. (Word limit: 300)
What led you to start your enterprise? Tell us how you went about starting it, how you
bootstrapped it, funded it, hired your first team etc. Yes, we would like to know all the details.
(Word limit: 500)
a) What is unique about what you do? Why do you think it is game changing?
b) What is the current scale of your enterprise? What are your revenues, how many
customers do you serve or people you add value to etc
c) Is your enterprise profitable/sustainable? Please provide relevant details to validate this.
d) How would you measure the impact of what you do?
Are there, or have there been, any legal cases filed against you or your enterprise? If yes, please
share the details.
() Yes () No
List web sites or links that will help us understand you and your enterprise better (such as your
enterprise’s website, your Linkedin profile, your blog, articles featuring your enterprise etc.)
Please provide three references who know you well. Please include their title, organization, email
address, phone and how you know them. Please indicate if your reference is part of TiE (it isn't
necessary that they are).
Reference1
Full Name:_____________________
Organisation: _________________________ Designation:__________________________
Email:_____________________________ Phone:_________________________________
How I know this person: ______________________________________________________
[] The person is a part of the TiE network
Reference2
Full Name:_____________________
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4. Organisation: _________________________ Designation:__________________________
Email:_____________________________ Phone:_________________________________
How I know this person: ______________________________________________________
[] The person is a part of the TiE network
Reference3
Full Name:_____________________
Organisation: _________________________ Designation:__________________________
Email:_____________________________ Phone:_________________________________
How I know this person: ______________________________________________________
[] The person is a part of the TiE network
Terms of application
[] By checking this box, I verify that I have read and agree to the Terms and Conditions of the
Made In India Search, that all above information is correct, and consent to possible reference
and background checks.
[] I agree to provide all necessary information relevant to the Made in India Search as required
by the organizers.
[] I also agree to travel to Mumbai at my own expense for the required Jury meetings and to the
Enterprising India 2011.
[] I hereby allow the organizers to publish all of the above information excluding my contact
information and that of my references.
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