Nomination FormSankalp Social EnterpriseAwards 2013Submission Deadline: January 20, 2013Email: email@example.comWebsite: www.sankalpforum.com
Instructions for Participation1. As an applicant/nominee to the Sankalp Social Enterprise Awards 2013 your enterprise should have an operational focus on India.2. Only operational enterprise registered as a for-profit business are eligible to apply for the Sankalp Social Enterprise Awards3. The enterprise should have been in operation for a minimum of six months before applying.4. Your enterprise must be catering to one of the following 5 high impact sector: i. Agriculture, Food and Rural Business ii. Clean Energy/Clean Technology iii. Education and Vocational Training iv. Health, Water and Sanitation v. Technology for Development5. This application is only for enterprises with a business operation focus in India. Completed nominations must be submitted at firstname.lastname@example.org Note: Last date of submission January 20, 2013. Late entries will not be accepted.Section 1 – Basic Information Full Name of the Company Full Name of the Founder (s) Promoter / Co-Promoters Operating since Month & Year Sector of Operation Agriculture, Food and Rural Business, Clean Energy/Clean Technology, Basic (choose only 1) Service Provision and Delivery (Health, Water, Sanitation, Education) Headquarter City StateGeographic Areas of Operation All India (Mention the states of operation) Email Mobile Number Landline Number WebsiteSection 2 – Understanding your Enterprise Date of Registration/ DD/MM/YYYY format Incorporation Legal Status Sole Proprietorship, Partnership Firm, Private Ltd Company, Producer (Choose one) Company with Pvt Ltd SubsidiaryWhat is the vision and missionof your company?
Have you received anyincubation support? Pleasemention details of theincubator, support receivedand duration.Section 3 – Opportunity and MarketWhat is the businessopportunity that your companyaddresses?Outline the size of the market Peopleopportunity Monetary value Reach ImpactWho are your primary target Please elaborate on numbers, type, location, monetary value, etc.audience/ client/ customer?Section 4 – Enterprise DetailsProvide details on the primary product/service that contributes to a majority of your company’s revenue.(maximum 3 products) Revenue Your position in theProduct Name Contribution (%) Description of product Top 3 Players marketProduct 1Product 2Product 3How do you access/reach out tocustomers? What are yourdistribution/delivery channels –how it operates?Are there any new products/solutions that you are looking tolaunch in the next 2 years?Please describeIf your product is technology-driven please explain yourtechnology or IP.
Section 5 – CompetitionWho are the top 3 players andwhat is their share? What is yourcurrent market share incomparison?What is your value proposition in Elaborate with examples on cost benefit, if your product is addressing acomparison with other players in specific customer pain point, unique technology, etcthe market?Section 6 – Product InnovationPlease describe yourproduct/service innovation.Elaborate on how it improvesyour enterprise’s efficiencyWhat is the impact of your Elaborate with examples on cost benefit, if your product is addressing aproduct/service innovation? specific customer pain point, unique technology, etcElaborate on its implications inyour scaling up strategies.Section 7 – TeamPlease mention details about the Leadership Team (Limit to 4 critical positions)Full NameCurrent Focus/ Area ofResponsibilityTitleNo. of years’ experience in sectorPrevious position 1Previous position 2Academic qualificationsRecognitions AwardsDo you have a Board ofDirectors/ Board of Advisors? Ifyes, please provide details ontheir role and profile.
Current employee strength Total EmployeesProjected employee strength in 3 Total EmployeesyearsSection 8 – Social ImpactWhat is the social impact that Note for e.g. these could be some of the ways you can create impactyour product/service hascreated? You source from disadvantaged/marginalized sections of society? OR You sell an essential product or service to marginalized/disadvantaged sections? OR You have a product that enables better delivery of an essential service to a section of the society OR You have a product/service that can benefit the environment/bring about energy efficiency? In short any solution that has a substantial positive impact on society!Section 9 – Financial ModelIndicate your current funding Debt: Amount and Sourcesstreams Equity: Amount and Sources Founders Stake: Amount and SourcesHow much investment are you INR Lakhsseeking for your enterprise?Show us what you have accomplished to date, financiallyParticulars INR Lakhs INR Lakhs INR Lakhs FY 2009-2010 FY 2010-2011 FY 2011-2012Total IncomeTotal ExpensesEBITDAProfit After TaxIf you have been operating forless than a year, what has beenyour capital burn out ratio ascompared to the revenue earned?What are the key milestones youaim to achieve with the capitalinfusion?
Identify 3 strategies that will help No of additional centers, distribution channels, assets, geographicachieve your growth targets in expansion etcthe next 18 months.What is your revenue estimation for next 3 years? (Projections)Particulars INR Lakhs INR Lakhs INR Lakhs FY 2012-2013 FY 2013-2014 FY 2014-2015Total IncomeTotal ExpensesEBITDAProfit After TaxPlease tell us what are the otherawards or recognitions yourenterprise has received?Lastly, why should yourenterprise win the SankalpAward?THANK YOU!Contact:Email: email@example.com Call: +91.22.40359212Website: http://www.sankalpforum.com/ Blog: http://blog.sankalpforum.com/Terms and Conditions* 1. The Sankalp Social Enterprise Award organizing committee does not take any responsibility for disputes related to awards given to entrepreneurs. 2. Winning the ‘Sankalp Social Enterprise Award does not guarantee an investment to your enterprise 3. This recognition is not a reflection of the quality/success of your enterprise and has been made by the sole discretion of the independent jury 4. The decision of the Sankalp Social Enterprise Award Jury with respect to selection of winners will be final and binding 5. All information disclosed via the nomination form will be kept confidential