ICT & Digital Outreach Awards 2014

Application Form A (Organisation / Project Team, Consultancy Firm) A 1. About the Business The Award(s) Category Applied For Name of the Applicant Organisation Business Address Website Contact Person for the Award(s) Designation Contact NumberTelephone: Mob. Name of the Highest Ranking Official Position Contact details Type of Organisation i. Large/Medium/Small/Micro ii. Manufacturing/ Service/ NGO/ Project Team Year of establishment Total number of Employees Name of the Parent organization, if any? Address Payment Details of Processing Fee

ICT & Digital Outreach Awards 2014 A 2. About the Organisation (not more than 300 words) Nature of the business: Products and/or Services, Project, Location(s), Major markets (local, regional, national, or international) and Principal customer types (consumers, other businesses, Government) etc. Also submit the documents separately (not exceeding 5 A4 size pages) substantiating achievements and innovations of your Organisation/ SBU/ Division/ Department/ Project Team relevant to the Award Category

ICT & Digital Outreach Awards 2014 Application Form B (individual Nomination) B 1. Contact Information Award Category Nominee Organisation Designation Address Telephone Mob. Years in Operation Nominated By Organisation Designation Address Contact No. Payment Details of Processing Fee

ICT & Digital Outreach Awards 2014 B 2. About the Nominee Reasons to nominate (not more than 250 words) Also submit the documents separately (not exceeding 3 A4 size pages) substantiating the achievements and initiatives of the Nominee for the Award Category.