APPLICATION FOR GOVERNOR’S BEST ENTREPRENEUR AWARD &

AMEA’S OUTSTANDING ENTREPRENEUR AWARD, 2020-2021

Sl. No......................
Sl. Particulars
1. Name of Enterprise

2. Name of Proprietor/ Promotor/ CMD

(if private Ltd. Co)
3. Contact No.
4. Email id
5. Website (if any)
6. Registered address

7. Factory address

8. UDYAM / Co. Regd. No and date of

registration
9. Date of commencement of commercial
production/ commercial activities
10. Nature of product(s)/ services

11. Brand name of the product

(if not in service sector)
12. Turnover in last three years
(2018-19/2019-20/2020-21)
13. Net profit in last three years
14. No. of employment 1) Adm. Div:
2) Production Div:
3) Others:
15. Market segment 1) Regional:
2) National:
3) International:
4) E-commerce/Online Sales:
16. Quality control system adopted – IS:
standards adopted if any
17. Is the unit established under any scheme
schemes, viz – PMEGP, Start-up or else
18 Name of bank/ financial institute those
financing the unit
19 Resume of the promoter

Signature & Stamp

Name of the Authorized Signatory

Designation

Recommendation Remark by GM/Concerned DIC:

Name of Authorized Signatory: Signature and Stamp

(TO BE FORWARDED / RECOMMENDED BY THE GENERAL MANAGER, DIC OF CONCERNED DISTRICT)

 APPLICATION FOR GOVERNOR’S BEST ENTREPRENEUR AWARD &
AMEA’S OUTSTANDING ENTREPRENEUR AWARD, 2020-2021

DOCUMENTS TO BE ENCLOSED:

1. Udyam Registration
2. ITR for 3 financial Year (2018-19/2019-20/2020-21)
3. Colour Passport Photo- 2 nos.
4. GST Certificate
5. PAN Card
6. Aadhar Card (for Proof of Address & Identification)
7. Passport (for Proof of Address & Identification)

DO’s & DONT’s:

1. Please use separate sheet if required.

2. All the supported Documents should be self attested with stamp.
3. Handwritten Application will be rejected. Only Computer Printout application will be
accepted.
4. The last date of submission through the concerned DIC is 09-03-2022.

(TO BE FORWARDED / RECOMMENDED BY THE GENERAL MANAGER, DIC OF CONCERNED DISTRICT)