Registration – VIA Udyog Gaurav Awards 2019

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Registration

VIA & SOLAR Vidarbha Udyog Gaurav Awards 2019

NOMINATION FORM

Form will take only 15 mins, 4 steps only

Step 1 of 4

25%

Name of Individual*
Email*
Phone Number*
Category*
- Large scale manufacturing units operating in any district in Vidarbha.
- Investment in plant or machinery and equipment is above 100 crores
- Medium scale manufacturing units operating in any district in Vidarbha.
- Investment in plant or machinery and equipment is between Rs. 10 crores to Rs. 100 crores
- Small-scale manufacturing units operating in any district in Vidarbha.
- Investment in plant and machinery and equipment is below Rs. 10 crores
- All manufacturing units with at least one woman founder or Directly promoter in any district in Vidarbha
- Manufacturing/Services unit with operations of less than 5 years in any district in Vidarbha.
- Technology Driven or Disruptive Business. Preferred to have Startup India Certificate
- All units operating or manufacturing unit in six districts in Vidarbha having least Gross District Domestic Product (GDDP).
- Companies from - Gondia, Bhandara, Gadchiroli, Akola, Washim & Buldhana.
- All manufacturing and service units operating in any district in Vidarbha, having min 25% export turnover.
- All service companies operating in any district in Vidarbha. Entity having income more than more than 50% from services in his total turnover.
I confirm that,
- I am authorized to submit this nomination on behalf of the organization mentioned below, &
- The information provided in this nomination form is correct to the best of my knowledge.
- The nomination submitted can be published in the VIA Enterprise and Knowledge portal
- I certify that the information provided is accurate uptill the best of my knowledge and I have proof of all of them which I can demonstrate after being shortlisted
- Joint applications, if any, can be filed individually but should also include a Letter of Support from the other parties involved especially
Accepted Terms*
- I have agreed to the Terms & Conditions

Common Fields
Name of Organization*
Type of Organization*
Turnover (Rs. Lakhs)
Turnover (₹ Lakhs)
FY 16-17*
FY 17-18*
FY 18-19*
Capital Expenditure (₹ Lakhs)
Capital Expenditure (₹ Lakhs)
FY 16-17*
FY 17-18*
FY 18-19*
Profitability (₹ Lakhs)
Profitability (₹ Lakhs)
FY 16-17*
FY 17-18*
FY 18-19*
Number of Employees (Permanent + Contractual)
Number of Employees (Permanent + Contractual)
FY 16-17*
FY 17-18*
FY 18-19
Common Fields End
Large Scale Industries
Number of Innovations in Product/ Bussiness Practices in past 3 years*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional).
This information will be required for second round
Number of Sustainability / CSR Initiatives taken in past 3 years*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief (Optional)
This information will be required for second round
Number of Corporate Governance Practices followed by your organization
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)
This information will be required for second round
Medium Scale Industries
Number of Innovations in Product/ Bussiness Practices in past 3 years*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)
This information will be required for second round
Number of Sustainability / CSR Initiatives taken in past 3 Years*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)
This information will be required for second round
Woman Entrepreneur of Year
Please Describe your Vision (in not more than 25 words)*
Number of Innovations in Product/ Bussiness Practices in
- Less than 2
- Between 2 and 5 years
- More than 5
Describe(Please provide this information in brief. (Optional))
This information will be required for second round
Your Role and Contribution in growing your venture*
In not more than 3 Bullet points
Best Startup of the year
Valuation
Valuation (₹ Lakhs)
FY 16-17*
FY 17-18*
FY 18-19*
Number of Innovation in Product/Bussiness practices in past 3 years*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)
This information will be required for second round
Please Describe your Vision (in not more than 25 words)*
Top 3 USP / Uniqueness of your start-up*
Best Exporter
Export Turnover
Export Turnover
FY 16-17*
FY 17-18*
FY 18-19*
Export Reach (no. of countries)
Export Reach (no. of countries)
FY 16-17*
FY 17-18*
FY 18-19*
Number of Sustainability / CSR initiatives taken in past 3 year*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)*
This information will be required for second round
Number of Initiatives taken to increase exports*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)*
This information will be required for second round
Best Service Provider
Service Turnover (₹ Lakhs)
Service Turnover (₹ Lakhs)
FY 16-17*
FY 17-18*
FY 18-19*
Number of Innovations in Product/ Bussiness Practices past in 3 years*
- Less than 2
- Between 2 and 5
- More than 5
Please provide this information in brief. (Optional)
This information will be required for second round

Page 3
Bussiness Projection for next 3 years
Turnover Growth*
- 0%-25%
- 25%-50%
- >50%
Employment Growth*
- 0%-25%
- 25%-50%
- >50%

Nominator's Details
Contact Person's Name*
Designation*
Contact Number*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Signature
Accepted file types: jpg, png, pdf.
Alternate Contact Person's Details
Provide Name and contact details of a person to be contacted in case of your absense
Name*
Phone*
Email*

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