Key Instructions:

All information in sections A & B are mandatory to be filled to enable us to consider your application.

Section C has open ended questions and if more space is required to provide more information, you may attach Annexures in the same format.

Any relevant support documents, brochures, awards won details, quality certifications, client testimonials, employee welfare scheme etc. may be submitted to strengthen your nomination.

for analysis only.

The Application Form is designed to elicit information for „UCCI Excellence Awards

process, and selection of the winners and their decision would be final.

Entry Fees: There is an entry fee of Rs.500 per Form, which may be remitted in

UCCI EXCELLENCE AWARDS 2018

Please provide all figures in Rs. Crore.

Audited Financial Statements for FY14-15, FY15-16. & FY16-17, are to be submitted.

Please note that all information provided will be kept strictly confidential and used

2018‟ only and will be used solely for this purpose.

UCCI and the Jury shall have full discretion regarding the eligibility, evaluation

favour of “Udaipur Chamber of Commerce & Industry”, by DD/Cheque/NEFT NEFT details given below: Account Name : Udaipur Chamber of Commerce & Industry Account No. : 51006002752 Type of A/c : Saving Bank A/c Name of Bank : State Bank of IndiaBank Address : Mewar Industrial Area, Madri, Udaipur – 313003 IFS Code : SBIN0031415

1. Small Enterprise Award - Manufacturing 2. Medium Enterprise Award -Manufacturing 3. Mid-Corporate Enterprise Award - Manufacturing 4. Large Enterprise Award - Manufacturing

The Application can be downloaded from www.ucciudaipur.com/excellence-awards-2018

APPLICATION FORM

Last Date for Submission: January 15, 2018

This Application Form is for the following Awards:

Eligibility Criteria:

1. Awards would be given to a firm or company and not to an individual.

2. Any firm or company having investment in Plant & Machinery above Rs.25 Lakhs, and

3. Any firm/company having its registered office outside Rajasthan can apply provided the manufacturing unit is in Rajasthan in any of the above specified districts of Rajasthan.

4. Any mining firm/company independently will not qualify for the awards, but if it has a manufacturing unit also, i.e. mineral or stone processing unit, it will be entitled to apply.

Eligibility Criteria for Category:

Category Investment in Plant & Machinery Turnover

Small Between Rs.25 Lakhs & Rs. 5 Crore If Turnover exceed Rs.100 crore, then unit would be considered in Mid-Corporate category

Medium Between Rs.5 Crore & Rs. 10 Crore

Mid-Corporate Above Rs.10 Crore Below Rs.500 Crore

Large Above Rs.10 Crore Above Rs.500 Crore

If you desire to send hard copies of the Form and other documents, please courier in

a sealed cover with title „UCCI EXCELLENCE AWARDS- 2018‟ to:

Udaipur Chamber of Commerce & Industry,

Chamber Bhawan,

which has Manufacturing Unit located in any of the following districts of Rajasthan: Udaipur, Sirohi, Dungarpur, Banswara, Chittorgarh, Rajsamand, Bhilwara, Pratapgarh, Kota, Bundi, Jhalawar & Ajmer will be eligible for the Awards.

The Application Form can also be downloaded from the above website and sent to ucciawards@gmail.com along with the Audited Financial Statements and other documents.

Chamber Marg, M.I.A., Udaipur-313003 Phones: (0294) 2491060, 2492215

For any queries please email us at ucciawards@gmail.com or contact: Mr. Anshul Mogra: 9772704777 Mr. Koustubh Bhattacharya : 9462701990

A.1] Ownership Pattern:

□ Proprietorship □ Partnership □ Private Limited □ Public Limited

□ Limited Liability Partnership (LLP)

A.2] Details of Main Promoter/Partner/Director

1

Name: Designation:

Mobile: Email id:

Gender: Male Female Age

2

Name: Designation:

Mobile: Email id:

Gender: Male Female Age

A.3] Please provide details of the person we should contact for any clarifications/further information:

Name: Designation:

Mobile: Email id: Landline No:

Gender: Male Female Age

Website:

No. of Manufacturing units:

Location of Manufacturing unit/s:

Location District State

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A] Basic Information

Registered Name of the Business: GST No* :

Registered Office Address:

Year of Commencement of Manufacturing Operations:

B] Business Operations & Performance

B.1] Please provide overview about your company’s business and major products it deals in:

(Maximum 200 words)

□ Between Rs 25 lakh and Rs 5 crore □ Between Rs 5 crore and Rs 10 crore □ Above Rs 10 crore

□ Below Rs.100 crore □ Between Rs.100 crore and Rs.500 crore □ Above Rs.500 crore

(In Rs. Crores)

Total Turnover / Sales

Net Profit (Profit after Tax)

Total Exports Sales

Equity (Share Capital)

Reserves & Surplus

Total Borrowings (Long Term + Short Term)

Fixed Assets

Total Expenditure incurred in CSR activities

B.2] Total Gross Investment as on 31 March 2017 in Plant & Machinery

B.3] Total Turnover in the F.Y. 2016-2017

B.4] Financial Highlights (AUDITED FINANCIALS FOR FY 2014-15, FY 2015-16 AND FY 2016-17 ARE MANDATORY TO BE ATTACHED AND SUBMITTED WITH THE FORM)

Particulars FY16-17 FY15-16 FY14-15

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B.5] No. of Countries Exported:

Please state the major areas of exports with % Breakup of exports

1 North America

2 Europe

3 Middle East

4 Africa

5 Asia Pacific (Excluding Middle East)

6 Others

B.6] Please provide details of contribution (in Percentage) of key customers to the Total Sales / Turnover

of your business:

Sr. No Names of Key Customers Type of Customer

(Domestic / Exports)

% Contribution to Total Sales in

B.7] EMPLOYEES

No. of Employees (Including temporary and contractual)

Males

Females

Total

Sr. No Region % Contribution to Total Exports in FY16-17

FY16-17

Particulars 31.03.2017 31.03.2016 31.03.2015

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C. KEY INITIATIVES & ACHIVEMENTS

If you need more space than what is provided in each of the boxes, you many attach Annexures with the sub-heading. C.1] Training & Skill Development Do you provide any training to employees? Yes No

If yes, please mention the major initiatives undertaken by the company with respect to training and skill

development of the employees (Maximum 200 words)

C.2] Quality Certifications

Provide details of the Quality & Credit rating Certifications received.

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C.3] Patents & Trade-Marks applied/received

Provide details of the Patents & Trade-Marks received or applied for.

Patent/Trade-Mark Status-Received/Applied

Year in which Received/Applied

C.4] Awards Provide details of any awards or accolades won in the past.

Award Name Basis or Category

Year Additional

Information

C.5] R & D efforts Provide details of the new products developed, quality improvement exercise undertaken, new technology adopted, technology agreements made. In short, all the R & D efforts & the Initiatives undertaken and achievements relating to Quality, Innovation, product design & modernization.

(Maximum 200 words)

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C.6] Environmental & Safety Provide details of the initiatives undertaken and achievements relating to Environmental Protection and Safety.

(Maximum 200 words)

C.7] Other initiatives & achievements

You may provide details of any initiatives, achievements relating to Processes, productivity enhancement, marketing and sales promotion, customer satisfaction, Human Resource Management, Employee Welfare, C.S.R. activities etc. that you would like to mention to strengthen your application.

(Maximum 200 words)

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D] Auditor Details

Name of the Auditor:

Address of the Auditor:

Contact No.:

Declaration

Name of the Respondent: __________________________________________________________________

Designation: _____________________________________________________________________________

Email: __________________________________________________________________________________

Date: ___________________________________________________________________________________

Signature: _______________________________________________________________________________

Firm/Company Stamp:_________________________________________________________________________________

Documents Submitted – Please tick Financial Statements for

FY 14-15

FY 15-16

FY 16-17

This is to certify that the all information in this application and accompanying documents are true and correct. I agree, on behalf of my organization, to abide by the rules of the „UCCI Excellence Awards-2018‟,

and accept that the decisions of the UCCI and Jury are final.

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