Preapplication form A Personal information First name Surname

Pre-application form A Personal information First name*: Surname*: Age*: (As on 1 st April 2010) Gender*: Male: Female: (Please tick as appropriate) B Basic business information Business name*: (As on company accounts) Business address*: (Headquarters/ Principal place of address) City/Town/Village*: Business website: (If any) Telephone* (incl. STD code) PIN code*: Fax (incl. STD code) C Business background information Brief description of current business (describe core product / service and key market(s) in 100 words or less) Year business was founded: D Basic financial performance FY 09 revenue* (audited figures if possible) (Rs. Lakh) Growth over last 5 years* (% calculated as (FY 09 revenues over FY 04 revenues - 1)) 0

Application form (additional fields) E Additional details on financial performance Profit after tax – FY 09 (Rs. Lakh) Net capital (including working capital) – FY 09 (Rs. Lakh) Please submit most recent year-end annual report, including year end report and accounts and chairman’s statement F Profile F 1 Please provide a brief description of your company’s products / services and the markets in which you operate (in 100 words or less). (if not provided by applicant in the pre-application form) F 2 What factors have contributed to your company’s success over the last 3 -5 years? What are the innovations in your business model that will ensure your success can be sustained in the future? (in 400 words or less). F 3 Describe the company’s growth vision – what are your growth plans for the next 3 -5 years? (in 250 words or less). F 4 Why should you be considered for the award? How will winning this award help your company in reaching the next horizon of growth? (in 400 words or less). 1

G References for you and your business (if required) Reference 1 Reference 2 Name : Telephone: How reference knows you / your business: (50 words) H Declaration and authority to use information Declaration of entrant: I confirm that to the best of my knowledge and belief, the information provided herein and in the profile and other documents attached is true and complete. I understand that the selection of successful entrants will be within the sole discretion of the panel of judges and that such decisions by the judges are final. I also understand that the judges’ panel reserves the right to deselect an entrant at any stage of the programme. I agree (please check this box) Signature Send in the filled-in application by email/ fax/ post on or before 5 th February 2010 to: S V Rajeeva Naag Confederation of Indian Industry 98/1, Velacherry Main Road Guindy, Chennai – 600 032 Email: rajeev. sistla@cii. in, Fax: 044 42 444 510, P: 044 42 444 555 2