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Name of Company*

Name of Contact Person*

Email Address*

Mobile Number*

Address of Company*

Company Website

Award Category*

Award Entry Ticket No. (Optional)

Give a brief description of your organization / yourself (in the case of individual awards) *max 200 words*

What is the unique proposition that your Brand / Product / Initiative / Organisation offers?
(This section should explain what is being submitted for consideration. W​​e​ look for new solution​s​ or an older solution implemented in a new way to achieve your objective) *max 200 words*

What is the impact that this has had across the last one year (1 April 2016- 31 August 2017)? *max 200 words
(You could also provide details of any awards ​or certifications your ​product / initiative has obtained in the last few months)*

Describe the potential of your ​Brand/Organisation/Product/Initiative in terms of its replicability and scalability that ensures a far-reaching effect? (*max 200 words)*

Kindly send the supporting documents to support@indiahealthsummit.com (Size Limit: 10 MB, PDF only). Please mention your Category & Organisation Name in the Subject Line.

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