Name of Company*

Name of Contact Person*

Email Address*

Mobile Number*

Address of Company*

Company Website

Awards Groups(Kindly fill the award group Gold/Silver/Bronze one) (This is not applicable for NGOs)*

Award Category*

—Please choose an option—WASH InitiativeCSR Food InitiativeCSR Health CampaignSwachh Bharat ImpactSwasth Bharat InitiativeEnvironment Impact InitiativeHealth CSR ProjectCSR Implementation PartnerHealth Impact NGORural Health InitiativeWomen and Child Health InitiativeElderly and Differently Able Health Initiative

Award Entry Ticket No.(It's required, Only If you are making an online payment)

Give a brief description of your organization(Limit – 200 words)*

When did the CSR project begin, who are the Stakeholders/ social groups for which the activity is undertaken and what is the unique proposition that your initiative offers?(Limit – 200 words)*

Describe the impact of your initiative? (Limit – 200 words)?*

In what specific ways is this scalable to ensure a far-reaching effect?*

How are the activities in the areas of CSR integrated into enterprise processes?*

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.