Advaita Nomination Form 2019: Women Entrepreneur Awards Nomination

Name of the Entrepreneur*

Name of the Organisation *

Founder of the Organisation*

I, myself	My Family Members	Others (Please Specify)

YEAR OF ESTABLISHMENT*

YEARS OF OPERATION*

6 months - 3 years	3 - 10 years	10 - 15 years	15 - 20 years	20 years & above

AGE OF THE NOMINEE*

18-25 Years	26-35 Years	36-45 Years	46 Years & Above

MARITAL STATUS*

Single	Married	Divorcee	Widow

STATE OF DOMICILE*

STATE FROM WHICH YOU WANT TO NOMINATE YOURSELF FOR ADVAITA AWARDS?*

Punjab

Haryana

Chandigarh

Office Address*



City*		Pincode*

Mobile Number*		Email ID*		Website URL

YOUR BUSINESS IS*

First Generation Business	Family Business	Other (Please Specify)

OWNERSHIP PATTERN*

Proprietorship	Partnership	HUF	Public Limited	Private Limited	Self-employed


Other (Please Specify)

YOU ARE APPLYING FOR*

MSME Award	Start-up Award

SELECT THE CATEGORY UNDER WHICH YOU ARE APPLYING FOR THE AWARD*

DO YOU HAVE PAN NUMBER?*		DO YOU HAVE TAN NUMBER?*		DO YOU HAVE GST NUMBER?*

REGISTERED UNDER MSMED ACT, 2006?		HAVE YOU EVER AVAILED SUBSIDY UNDER MSMED ACT, 2006?*

HAVE YOU BEEN FUNDED UNDER ANY OF FOLLOWING SCHEMES*

MUDRA	KVIC/ Prime Minister Rozgar Fund	MSME	Bank	None	Other (Please Specify)

ARE YOU REGISTERED WITH ANY INDUSTRY OR WOMEN ASSOCIATION?*

Yes	No	If yes, please specify

HAVE YOU EVER PARTICIPATED IN EXHIBITION?*

National

International

ANNUAL TURNOVER*

RESOURCES*

Number of Employees	Tick the Vehicles that You Own	Number of Computers Owned

Self-Declaration

I certify that my responses are correct and complete to the best of my knowledge and that I am solely responsible for their accuracy. I am also aware that furnishing false information in this form may result in me being disqualified from Advaita awards at any point of time.
I certify that my business is registered or has a head office/industrial unit in the state from which I am nominating myself for Advaita awards.
I undertake that I will not nominate myself for Advaita awards in the future from any other state except the one that I have selected in this form.

* All fields are mandatory

YEAR OF ESTABLISHMENT*

YEARS OF OPERATION*

AGE OF THE NOMINEE*

MARITAL STATUS*

STATE OF DOMICILE*

STATE FROM WHICH YOU WANT TO NOMINATE YOURSELF FOR ADVAITA AWARDS?*

Mobile Number*

Email ID*

Website URL

YOUR BUSINESS IS*

OWNERSHIP PATTERN*

YOU ARE APPLYING FOR*

SELECT THE CATEGORY UNDER WHICH YOU ARE APPLYING FOR THE AWARD*

DO YOU HAVE PAN NUMBER?*

DO YOU HAVE TAN NUMBER?*

DO YOU HAVE GST NUMBER?*

REGISTERED UNDER MSMED ACT, 2006*?*

HAVE YOU EVER AVAILED SUBSIDY UNDER MSMED ACT, 2006?*

HAVE YOU BEEN FUNDED UNDER ANY OF FOLLOWING SCHEMES*

ARE YOU REGISTERED WITH ANY INDUSTRY OR WOMEN ASSOCIATION?*

HAVE YOU EVER PARTICIPATED IN EXHIBITION?*

ANNUAL TURNOVER*

RESOURCES*

REGISTERED UNDER MSMED ACT, 2006?