Made in india search 2012

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Made in india search 2012

  1. 1. Made In India Search 2012: Application FormWe would like to showcase inspiring and innovative enterprising Indians and enterprises at “TiEEntrepreneurial Summit”- a TiE Mumbai initiative on 20th & 21st December 2012.The showcased enterprises and entrepreneurs would be diverse, dynamic and distinctive, and they wouldopen our eyes, engage our imagination and inspire us to aim higher and go further. They can be for-profitor not-for-profit enterprises.We would showcase three such enterprises across each of the following three areas:Health is WealthServing the Indian ConsumerTech that TransformsThe nominated enterprises would be evaluated and selected by the Made in India core committee, whosedecision will be final. We recommend that you download the form and fill it offline before you submit ithere. The form can be downloaded from here: __________Last date for form submission: 31st Oct, 2012, 23:59 hrs* RequiredPersonal Details:Full Name: ___________*Gender: _________*Age: _______*Job Title and Role: _________*Organisation Name: _______________*Phone: Mobile | Landline with STD code: ____________*Email: ______________*Address:___________________________________________________________________________________________.*
  2. 2. Application | About Yourself/Enterprise:Nomination type:*  Enterprising Individual  Enterprising Group  Enterprising EcosystemEnterprise type:*  For Profit Enterprise  A Social Enterprise  An enterprising Act/ MovementChooses the Nomination category(ies) that best describes your enterprises focus:  Health is Wealth  Serving the Indian Consumer  Tech that TransformsEnterprise StatsNo. of yrs in business: _______________.*Turnover:* o < 10 Lakhs o 10 Lakhs – 50 Lakhs o 50 Lakhs – 1 crore o 1 crore – 10 crores o 10 crore – 50 crores o 10 crore – 50 crores o 50 crore – 100 crores o > 100 croresTeam Size: * o 1 – 10 o 11 – 50 o 51 – 100 o 101 – 250 o 251 – 500 o 501 – 1000 o 1001 – 1500 o 1501 – above
  3. 3. Tell us about yourself and what you doThis section is important, please take the time to answer the questions thoughtfully, with enough detail tohelp us understand who you are and what you do. All responses are limited to 250 words except wherenoted.Tell us about yourenterprise (Word Limit: 300):*What other achievements would you like to share?*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) Is your enterprise profitable/sustainable? Please provide relevant details (P&L statements) to validate this.* c) How would you measure the impact of what you do? d) Geographies you operate out of. *Are there, or have there been, any legal cases filed against you or your enterprise? If yes, please share thedetails.*  Yes  NoList web sites or links that will help us understand you and your enterprise better (such as yourenterprise’s website, your Linkedin profile, your blog, articles featuring your enterprise etc.)*ReferencesPlease 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 isnt necessary that theyare). All three compulsory *Format: Full Name:_____________________ Organization: _________________________Designation:__________________________ Email:_____________________________Phone:_________________________________ How I know this person:______________________________________________________ [] The person is a part of the TiEnetwork
  4. 4. Terms Of ApplicationYou must comply and abide with the following terms to be eligible to nominate yourself for the Made InIndia Search.By checking this box, I verify that I have read and agree to the Terms and Conditions of the Made InIndia Search, that all above information is correct, and consent to possible reference and backgroundchecks. * I agreeI agree to provide all necessary information relevant to the Made in India Search as required by theorganizers.* I agreeI also agree to travel to Mumbai at my own expense for the required core committee meetings and to theTiE Entrepreneurial Summit 2012. * I agreeI hereby allow the organizers to publish all of the above information excluding my contact informationand that of my references. * I agree

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