IMC RBNQA

Official Name * :

Other Name :

Headquarters Address * :

Highest-Ranking Official * :

Name :

Address * :

Telephone * :

Mobile * :

Fax * :

E-mail * :

Award Category For-Profit/ Nonprofit Designation (Check as appropriate) * :

Manufacturing (For Profit only)

Service (For-Profit only)

Small Business (For-Profit Only)

Indian Overseas Business (For-Profit Only)

Education

Health Care

Size and Location of Applicant

A. Total Number of
Employees (Business):

Faculty/Staff (Education) :

Staff (Health Care)
(this includes contract workforce) :

B. Sales in the preceding fiscal year (in Crores) :

0 - Rs.100 Cr

Rs.100 Cr - Rs 1000 Cr

1000 Cr.- Rs.10000 Cr

More than Rs.10000 Cr

Number of Sites :

Terms and Conditions * :

I state and attest that I have reviewed the information provided by my organization in this Eligibility Package to the best of my knowledge. No untrue statement of a material fact is contained in this Eligibility Package, and no omission of a material fact has been made in this package. I understand that at any time during the Award Process cycle, if the information is found not to support eligibility, my organization will no longer receive consideration for the Award.

Signature and Name of the Highest-Ranking Official :

Participation Policy for Examiners

Eligibility Determination Form

Size and Location of Applicant

B. Sales in the preceding fiscal year (in Crores) :