Nomination / Application Form

Please take a moment to carefully fill in all the required details in the form. Ensure the information provided is accurate and complete. The last date for submission is 31st October 2025. Forms received after this date may not be considered.

Personal Profile

Date of Birth

Professional Profile

Nature of Business Activities over the years (200–250 words):

Impact of work on Rural Development & Entrepreneurship:

Impact on Surrounding Areas (villages/districts):

Impact on Individuals / Communities benefitted:

In what way is the work Outstanding:

In what way is the work Innovative:

In what way is showing continuity and potential for future development:

Financial Position of the Enterprise (attach current year and previous two years’ Balance Sheet & P&L):upload .pdf files only

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Additional Information

Details of Awards / Prizes / Recognitions received (if any):

Photographs of work done (3–5 images) / links to videos: You may upload 3–5 images. Add links to videos below:

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Nomination Type

Self-Nominated:

YesNo

If proposed by someone else, Proposer’s Details:

Signature of Proposer:

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Source of Information

Mention where you heard about the Puraskar (e.g., IMC, media, social media, referral):

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Mandatory Documents

1. Enterprise Registration Certificate (if applicable)

2. Balance Sheet & Profit & Loss Account – current year and preceding two yearsupload .pdf files only

3. Government-issued ID of Applicant (Aadhaar/other)

4. Recent photographs of the Nominee (passport size)

5. Photographs of work done (3–5 images)

6. Optional: Media coverage / testimonials / case studies

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Declaration

I hereby declare that all information provided is true and correct to the best of my knowledge. I agree to provide clarifications and additional documents if requested by the Jury/Organising Committee.

Signature / Thumb Impression of Applicant:

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