1. Your Name :

2. Your Email :

3. Country

4. Country Code :

5. Contact No:

6. Address

7. Your Profession/Occupation :
---Business/Self EmployedService

8. Company Name (if any)

9. Are you incorporated, If yes mention the year of Incorporation

10. Brief about your business / work

11. Recent Job Designation

12. Industry Type

13. Highest Qualification

14. Which category are you applying for awards ( City/Sector either of them can be applicable) :
---100 smart citiesSector

15. Your Social Media links

16. Experience(Years)

17. Whether held any importent position in Government (Yea/ No) :

18. Is your business innovative?
---YesNo

19. How do you think your business is innovative?

20. Where did you get reference from :
---InfluencerSocial MediaWebsitesFriends/familyOthers

21. Which category of business are you into :
---ServicesManufacturing

22. Define the size of your business (turnover) :
---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 :
---IdeaUnregistered Startup1 to 3 year old3 to 6 year old6 to 10 year old10 plus yearsNot Applicable

24. Number of employees :
---1 to 55 to 2020 to 100100 plusNot applicable

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

26. Write your journey to success in 100 words :

27. Upload Your Picture :

28. Anything else you would like to mention :

29. Refer atleast one person in your close network who is eligible to apply for women faces(Name, Email, phone) :

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.