Eligibility Determination Form : : IMCRBNQA : : IMC Ramkrishna Bajaj National Awards

* 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)

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

	0 - Rs.100 Cr		Rs.100 Cr - Rs 1,000 Cr
	1,000 Cr.- Rs.10,000 Cr.		More than Rs.10,000 Cr

Number of Sites

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 2008 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

IMC RBNQA > 2008 Eligibility Determination Form