‘Made in India Search’ Application Form
We would like to showcase inspiring and innovative enterprising Indians and enterp...
Your personal details

First Name:___________________
Last Name: ________________________
Gender: () Male () Female
Age: _...
What other achievements would you like to share?


Tell us about your enterprise. (Word limit: 300)

What led you to start...
Organisation: _________________________ Designation:__________________________
Email:_____________________________ Phone:_...
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Made in India Search Nomination form 2011

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This form needs to be submitted online here by 23:59 hrs, 25 Jan, 2011.

http://spreadsheets.google.com/viewform?formkey=dHM4SmswbHRsVVVSOEFtZ0x6enJrNnc6MQ

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Made in India Search Nomination form 2011

  1. 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 > Made in India Search 1/4
  2. 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.) Made in India Search 2/4
  3. 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:_____________________ Made in India Search 3/4
  4. 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. Made in India Search 4/4

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