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INSTRUCTIONS FOR COMPLETING THE APPLICATION FORM

A. Objective of these Awards are:To celebrate and recognize Women Entrepreneurs.

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Award Category DefinitionMicro Enterprises A business whose annual turnover is between Rs. 1 Lakh and

Rs. 10 Lakhs

Small Enterprises A business whose annual turnover is between Rs. 10 Lakhs and Rs. 2 Crores

Emerging Enterprises A business whose annual turnover is between Rs. 2 Crores and Rs. 10 Crores

Medium Enterprises A business whose annual turnover is between Rs. 10 Crores and Rs. 25 Crores

C. Broad Evaluation CriteriaInnovativeness of the concept

Overcoming socio economic/ familial challenges

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Social goodGenerating employmentScale of operations

D. When completing the application forms: Use permanent ink only – please do not use pencil

The entry form needs to be signed, at the space provided, by the participant (founder/ MD/ CEO, Chairman/ Director) and any of the following: senior employee, client or banker

E. Other important matters: Participants should be Indian citizens, at least 18 years of age (as on January 1, 2011) and

entrepreneurial women who have founded/ successfully led companies/ cooperative societies/ sole proprietorships/ partnerships/ etc and currently have at least 3 workers/ members of staff employed (excluding self).

The form can also be downloaded from our website- www.TiEStreeShakti.org

Please send the completed and signed form to

TiE Mumbai, 301, Turf Estate, Shakti Mills Lane, Off Dr E Moses Road, Mahalaxmi, Mumbai – 400 011. (Phone 022-42200100 -11 or 022- 64510062)

Each form can be used only for a single Entry If you have any questions about the application form, please contact 022-42200100 -11 or

022- 64510062 or email us at info@tiestreeshakti.org Please refer to the Rules & Regulations document for additional guidelines on participation

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GENERAL & PARTICIPANT INFORMATION

Name of participant:______________________________________________________________Name of the participating organization:______________________________________________________________Type of organization:

Company Registered Society Partnership

Sole Proprietorship

Other (please specify): _________________________

Correspondence Address:_____________________________________________ ___________________________________________________________________________________

City _________________ _: State __________________:

Pin code:____________

:____________Office Phone:

(STD code):_______ (No.):_______________

Fax No.:____________________ Mobile (0):_______________________

Email:__________________________________________

Website: _____________________________________

Designation of the participant in the organization

:______________________________________

Current Chief Officer Mr./ Ms.

____________________________________________________

2 Photos

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Presence of the organization’s activities in India (states)

:________________________________________________________________Date of commencing operations (DD/ MM/ YYYY ___________________:)

Total amount of initial funding Rs._________________

Source of initial funding ___________________________

___________________________Industry of operation

What does the organization do? What are its key product/ service or product offerings? (in not more than 3 sentences )

1. __________________________________________________________________________ ____________________________________________________________________________ 2. __________________________________________________________________________ ____________________________________________________________________________ 3. __________________________________________________________________________ ____________________________________________________________________________

Who are the organization’s key customers? (in not more than 50 words)

__ __________________________________________________________________________

What is the progress of the organization?

(estimate) 2007 - 08 2008 - 09 2009 – 10

No. of Employees

No. of Customers

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APPLICATION FORM

A. Category applied for

Micro Small Emerging Medium

B. Give details about your entrepreneurial initiative for each of the following Criteria. Additional details, if any, can be attached with this application form

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Parameter DetailsInnovativeness of the concept (How is your initiative new/ different?)

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. What socio-economic/ familial challenges/ hardships did you face from the time you started the organization? How did you overcome them? (in not more than 100 words).(E.g. Societal boycott, family opposition, lack of funding, etc)

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

I accept the rules and regulations of participation. The information provided is correct to the best of my knowledge and belief.

Name of Participant Title Signature

Email: ________________________________________________________________

Mobile (0):_______________________ _________________________ :etaD