1. Name / नाम

2. Email / ईमेल :

3. Country / देश:
---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo (Congo-Brazzaville)Costa RicaCroatiaCubaCyprusCzechia (Czech Republic)Democratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (fmr. "Swaziland")EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPalestine StatePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweOther

State/राज्य :

4. City/ शहर :

5. Contact No / दूरभाष/ मोबाइल:

6. Address / पता :

7. Your Profession/Occupation / आपका व्यवसाय :
---Business/Self EmployedServiceSocial ActivistDigital InfluencerInformation TechnologyOthers

8. Company Name (if any)/ कंपनी का नाम:

9. Are you incorporated, If yes mention the year of Incorporation / आपकी संस्था की स्थापना हुई है ? यदि हाँ तो स्थापना का वर्ष बताएं :
Not ApplicableNot incorporated2001- 20102011-20202021 <

10. Brief about your business / work /संछिप्त में अपने व्यवसाय के बारे म बताये:

11. Recent Job Designation/ पदनाम :

12. Industry Type / उद्योग के प्रकार :
---Environment, Waste Management & Energy ConservationHealthcare, Mental & WellnessBeauty and WellnessPower and energyArchitect, Housing Development, Interior DesignCivil AviationHREducationEntertainment , Media , Art & CultureAgri Business & Food Processing & Organic FarmingBanking , Financial Services & InsurancePower, renewable and Alternative EnergyMicro, Small and Medium EnterprisesSports & Youth AffairGold Gem & Jewellery, Fashion & Luxury LifestyleLaw & JusticeBusiness Practices & AwardsDefence & HLS AerospaceParliamentary ForumScale & Entrepreneurship DevelopmentDirect Marketing/Direct SellingEducationMembership DevelopmentHospitality & TourismCSR CouncilIT, ITEs & E CommerceCyber Security & Cyber LawFMCG, Brand Promotion and ProtectionPharmaceuticalManufacturingArtificial Intelligence/ Blockchain Technology/Digital TransformationHuman Resouce & Management and training and developmentTransportation & LogisticsPublic Procurement CommitteeScience & TechnologyTextiles & ApparelDigital MarketingWomen Empowerment & DevelopmentCorporate AffairsInfrastructure & Real EstateLiteratureEvent Management, Seminars, Conclave & SummitOthersNot Applicable

13. Highest Qualification / उच्चतम योग्यता :

14. Which Sector:
---Sector

15. Your Social Media links/ आपके सोशल मीडिया लिंक:

16. Experience(Years)/अनुभव (वर्षों):
---Less than 1011 - 2021 - 3031 and moreNot applicable

17. Whether held any important position?/किसी भी संगठन में महत्वपूर्ण पद?:

18. Is your business innovative?/क्या आपका व्यवसाय नवीन है?
---YesNo

19. How do you think your business is innovative?/आपको कैसे लगता है कि आपका व्यवसाय अभिनव है?

20. Where and from whom did you get reference from/आपको संदर्भ कहां से मिला?

21. Which category of business are you into/आप किस व्यवसायक श्रेड़ी में हे?
---Not ApplicableServicesManufacturing

22. Define the size of your business (turnover)/अपने व्यवसाय के प्रकार को परिभाषित करें (टर्नओवर):
---Micro (up to 5 crore)Small (5 crore to 75 crore)Medium (75 crore to 250 crore)Not Applicable

23. What is" the stage of your Business/आपके व्यवसाय किस स्टेज पर हे ?
---IdeaUnregistered Startup1 to 3 year old3 to 6 year old6 to 10 year old10 plus yearsNot Applicable

24. Number of employees/कर्मचारियों की संख्या :
---1 to 55 to 2020 to 100100 plusNot applicable

25. Funding Details/धन का विवरण :
---Bootstrapped (self funded)Funded by friends and familyFunded by other, if any specify …..Not Applicable

26. Write your journey to success / सफलता के लिए अपनी यात्रा को शब्दों में लिखें :

27. Upload Your Picture:

28. Refer atleast one person in your close network who is eligible to apply for women faces(Name, Email, phone) / अपने करीबी जानकारी में कम से कम उन लोगों का संदर्भ लें जो वूमेन फेस (नाम, ईमेल, फोन) के लिए आवेदन करने के लिए पात्र हैं :

I hereby declare the information provided by me is correct to the best of my knowledge and I am aware that in case of any wrong and incorrect information my application is liable to be rejected.