Form 2019

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Sambad Awards 





														Section 1






All fields are mandatory. Kindly fill all the fields properly before submitting the form.				




Name of the Organisation




Registered Address




Odisha HQ Address




Contact Number




Email ID




Year of Establishment



Type of Organisation
						Organizations opting for Corporate Social Responsibility(CSR) may also apply for any other type of organization in another Application Form.



CSR	



Large	



Medium	



Small	



Emerging/Start Up	




Line of Activity




Key Products/Services




Name of CMD/MD/Key Promoter


														Section 2




Authorised Contact Person




Authorised Person Contact Number




Authorised Person Email ID




Vision/Mission of the organisation




Number of Employees in the organisation





Financial Data ( In Lacs)				







2016-17				




Gross Turnover (Excluding Tax - In Lacs)




Export Turnover (If Any In Lacs)




Sales Turnover Outside Odisha (In Lacs)







2017-18				




Gross Turnover (Excluding Tax - In Lacs)




Export Turnover (If Any In Lacs)




Sales Turnover Outside Odisha (In Lacs)







2018-19				




Gross Turnover (Excluding Tax - In Lacs)




Export Turnover (If Any In Lacs)




Sales Turnover Outside Odisha (In Lacs)



Location/s of Operation Outside Odisha


Location/s of Operation Outside Odisha




Achievements /Awards ( if any)


						
Upload the awards/ Certificates Images
Max file size: 2.00 MB. | Allowed file types: zip,tar,rar | Max number of file: 1


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Documentary Proof(Pls Attach) Financial Statements filed with ROC for Last 3 Years / (Audited Financial Statements)
Max file size: 2.00 MB. | Allowed file types: zip,tar,rar | Max number of file: 1


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Organization Opting for CSR - Provide details of CSR Activities conducted, Amount Spend, Awards, Certificates and Photos.


						
CSR Activities Awards, Certificates and Photos.
Max file size: 2.00 MB. | Allowed file types: zip,tar,rar


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Name of Authorised Signatory




Designation of Authorised Signatory


						
Scanned Signature with  Organisation Seal
Max file size: 2.00 MB. | Allowed file types: jpg,jpeg,png,tiff,pdf | Max number of file: 1


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I/We do hereby declare that above information is true to the best of my/our knowledge & belief.				

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