Award Nomination Form

Nomination Fee
 Hospitals:  INR 11,000 + GST(23.9%) = INR 13,629/-
 Private:  INR 11,000 + GST(23.9%) = INR 13,629/-
 Corporate:  INR 20,000 + GST(23.9%) = INR 24,780/-
Note: GST 18% + (Online Bank Transfer Charges + Transfer GST charges) @ 5.9% = 23.9%

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Award Category :*

Details of Applicant

Name:*
Designation:*
Name of Organisation:*
Address:*
City:*
State:*
Country:*
Postal Code:
Mobile No:*
(with country code)
E-Mail:*
Website:
Facebook page of the Organisation:
LinkedIn page of the Organisation:
Twitter Handle of the Organisation:

Details of Project / Initiative

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Brief Description:*
(Maximum file size 1 MB in doc or pdf format)
Upload Organisation Logo:*
(Maximum file size 1 MB in jpeg, jpg or png format)