1. IMC Inclusive Innovation Awards, 2014 Application Form 1

2. IMC Inclusive Innovation Awards, 2014 Guidelines: 2 1.Fill in the form just as you would on paper, by typing your information in the supplied fields 2.Please fill all information with complete accuracy and to the best of your knowledge. Please provide most latest data / information. 3.You may use bullet points, diagrams, charts and other data is appropriate. 4.You may save your application to your local drive or directly on a USB key, at any time, without being connected to the Internet while filling the Form. 5.Do make sure that your email addresses are correct and that your accounts are not over quota; the IMC Inclusive innovation Cell will be sending you all communications on the email address provided by you in the Application Form. 6.Please read the Notes to this Form as also IMC Inclusive Innovation Awards, 2014 Brochure for more information and guidance.

3. IMC Inclusive Innovation Awards, 2014 Notes: 3 1.Receipt of entries after last date of receipt specified may be permitted only at the discretion of the Awards Management. 2.Awards Management will not be responsible for Application Forms that are lost in transit / received late. 3.If Applicant desires to send the entry in hard copy, that should be submitted to IMC’s Office at Churchgate, Mumbai in an envelope marked “ IMC Inclusive Innovation Award, 2014”. 4.The Application Form needs to be completed and signed by the individual submitting the application and in case of application by an organization, it must be signed by senior officer of the organization (from amongst the MD, CEO, COO, CFO, Chairman, Directors, Partner, Trustee, etc.). 5.Incomplete Application Forms received through any mode will disqualify the Applicant from participating in the Awards. 6.Disqualification of entries received is at the sole discretion of Awards Management, on a case by case basis.

4. IMC Inclusive Innovation Awards, 2014 A - Participant / Applicant Details for Company / Organization Applicants (other than individuals) : Name of the Company / Organization: Name of Founder / CEO: Date of Incorporation: No. of Employees: Office / Communication Address: Contact No. of Founder / CEO: Email id of Founder / CEO: Web Address: 4

5. IMC Inclusive Innovation Awards, 2014 A- Participant / Applicant Details for Individual Applicants (other than Company / Organization): Name: Office / Communication Address: Contact No: Email id : Web Address: Whether associated with any Organisation / NGO / NPO / Government Organisation – Which one and the nature of relationship? No. of Employees: 5

6. IMC Inclusive Innovation Awards, 2014 B- Inclusive Innovation (Product or Service) Details: Title of Innovative Product / Service Brief Description of Innovative Product / Service Date when Innovative Product / Service was launched If not launched, expected date of launching ? Place / State where Innovation is launched / to be launched Where is the Product / Service available,if it is launched ? If so, what is the manner in which it is distributed / how are you reaching out to the potential clients? How was the development of the Product / Service funded ? What are the unique features of the Product / Service which makes it Inclusive and Innovative ? 6

7. IMC Inclusive Innovation Awards, 2014 C- Market/ Industry / Sector Details : Which is the specific difficulty / problem your Product / Service seeking to resolve? What are the existing solutions available to address the problem that your Product / Service is resolving and what are the inadequacies of those solutions? How is your Product / Service addressing the problem and the inadequacies of existing solutions? Who are the direct beneficiaries of the innovation (e.g. teachers, doctors, students, rural people, disabled people)? 7

8. IMC Inclusive Innovation Awards, 2014 D- Commercial Aspects : What is the current market size for your Innovative Product / Service ? How much is the market share of the existing products? Who are the major competitors? -Within India - Outside of India What is the nature of competition faced by the Innovator – Technology / Pricing / Qualtiy ? (Please give details) How is product safeguarded from new entrants in the same segment? What are the hindrances the Innovator envisages for new entrants? What is the potential of the Product / Service to face the competition and increase its market share? 8

9. IMC Inclusive Innovation Awards, 2014 E - Pricing Analysis : What is the Price Point of the Product / Service vis-à-vis existing competing product? / service? Who are the target Customers / Segment? Does the Product / Service benefit from change in any existing Economic / Commercial / Financial or Government Policies? Does the Product / Service pricing dependent on any Grants / Subsidies in any form? Would the Product / Service pricing be flexible with increase in Production / Sales? 9

10. IMC Inclusive Innovation Awards, 2014 F- Marketability Analysis : 10 What are the salient features of the Product / Service that will garner market / customer interest (footfalls or eyeballs)? Is the Product / Service adaptable to different market segments / geographies / economies, changes? What is the shelf life of the Product / Service?

11. IMC Inclusive Innovation Awards, 2014 G- Patents / Copyrights : 11 Will the Product / Service need protection from intellectual property perspective? Has the product been patented – appropriate steps taken to safeguard the Innovation? If not, is there a plan for getting the product patent?

12. IMC Inclusive Innovation Awards, 2014 H- Product Design / Brochure / Pictures / Publications : Please attach 12

13. Please provide details IMC Inclusive Innovation Awards, 2014 I- Awards received, if any : 13

14. IMC Inclusive Innovation Awards, 2014 J- How the Award Money would help the Innovator / Innovation? 14

15. IMC Inclusive Innovation Awards, 2014 K- How can IMC Innovation Award Cell help the Innovator / Innovation? 15

16. IMC Inclusive Innovation Awards, 2014 Declaration 16 I/We confirm that we possess requisite intellectual property rights to the material/data/information submitted as also to the product/service submitted for consideration of the Award. By making this application, I/we, grant requisite license/permission to IMC to announce, display, project the applicant/awardee and the product and/or service, as the case may be, and take all steps considered appropriate by IMC, in their sole discretion. I/We confirm that the decision of Jury/IMC shall be final and binding in this regard. I/We have read the Terms and Conditions of the Award and accept the same. ____________________________ (Signature of the Applicant) * Please sign incase of hard copy submission or provide digital signature