1. 0 A A Personal information First name:Surname: Age: (As on 1 st April 2010) Gender: (Please tick as appropriate) Male:Female: B B Basic business information Business name: Business address*: (Headquarters/ Principal place of address) City/Town/Village:PIN code: Business website: (If any) C 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: Telephone (incl. STD code) Fax (incl. STD code) D 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)) Pre-application form Email id:Mobile no: Does applicant have majority shareholding? (Please tick as appropriate) YesNo Year applicant reached current designation: Applicant designation:

2. 1 E E Additional details on financial performance Profit after tax – FY09 (Rs. Lakh) Net capital (including working capital) – FY09 (Rs. Lakh) Please submit most recent year-end annual report, including year end report and accounts and chairman’s statement Application form (additional fields) F F Profile 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) F1 Describe the company’s growth vision – what are your growth plans for the next 3-5 years? (in 250 words or less). F3 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). F2 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). F4 Number of employees (#)

3. 2 G G References for you and your business H H Declaration and authority to use information Reference 1Reference 2 Name : Telephone: How reference knows you / your business: (50 words) I agree (please check this box) Signature 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. 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 555rajeev.sistla@cii.in Send in the filled-in application by email/ fax/ post on or before 5 th February 2010 to