1. Made In India Search 2012: Application Form
We would like to showcase inspiring and innovative enterprising Indians and enterprises at “TiE
Entrepreneurial Summit”- a TiE Mumbai initiative on 20th & 21st December 2012.
The showcased enterprises and entrepreneurs would be diverse, dynamic and distinctive, and they would
open our eyes, engage our imagination and inspire us to aim higher and go further. They can be for-profit
or not-for-profit enterprises.
We would showcase three such enterprises across each of the following three areas:
Health is Wealth
Serving the Indian Consumer
Tech that Transforms
The nominated enterprises would be evaluated and selected by the Made in India core committee, whose
decision will be final. We recommend that you download the form and fill it offline before you submit it
here. The form can be downloaded from here: __________
Last date for form submission: 31st Oct, 2012, 23:59 hrs
* Required
Personal Details:
Full Name: ___________*
Gender: _________*
Age: _______*
Job Title and Role: _________*
Organisation Name: _______________*
Phone: Mobile | Landline with STD code: ____________*
Email: ______________*
Address:_____________________________________________________________________________
______________.*

2. Application | About Yourself/Enterprise:
Nomination type:*
 Enterprising Individual
 Enterprising Group
 Enterprising Ecosystem
Enterprise type:*
 For Profit Enterprise
 A Social Enterprise
 An enterprising Act/ Movement
Chooses the Nomination category(ies) that best describes your enterprise's focus:
 Health is Wealth
 Serving the Indian Consumer
 Tech that Transforms
Enterprise Stats
No. of yrs in business: _______________.*
Turnover:*
o < 10 Lakhs
o 10 Lakhs – 50 Lakhs
o 50 Lakhs – 1 crore
o 1 crore – 10 crores
o 10 crore – 50 crores
o 10 crore – 50 crores
o 50 crore – 100 crores
o > 100 crores
Team Size: *
o 1 – 10
o 11 – 50
o 51 – 100
o 101 – 250
o 251 – 500
o 501 – 1000
o 1001 – 1500
o 1501 – above

3. Tell us about yourself and what you do
This section is important, please take the time to answer the questions thoughtfully, with enough detail to
help us understand who you are and what you do. All responses are limited to 250 words except where
noted.
Tell us about yourenterprise (Word Limit: 300):*
What other achievements would you like to share?*
What led you to start your enterprise? Tell us how you went about starting it, how you bootstrapped it,
funded it, hired your first team etc. Yes, we would like to know all the details. (Word limit: 500)*
a) What is unique about what you do? Why do you think it is game changing? *
b) Is your enterprise profitable/sustainable? Please provide relevant details (P&L statements) to
validate this.*
c) How would you measure the impact of what you do?
d) Geographies you operate out of. *
Are there, or have there been, any legal cases filed against you or your enterprise? If yes, please share the
details.*
 Yes
 No
List web sites or links that will help us understand you and your enterprise better (such as your
enterprise’s website, your Linkedin profile, your blog, articles featuring your enterprise etc.)*
References
Please provide three references who know you well. Please include their title, organization, email address,
phone and how you know them. Please indicate if your reference is part of TiE (it isn't necessary that they
are). All three compulsory *
Format: Full Name:_____________________ Organization: _________________________
Designation:__________________________ Email:_____________________________
Phone:_________________________________ How I know this person:
______________________________________________________ [] The person is a part of the TiE
network

4. Terms Of Application
You must comply and abide with the following terms to be eligible to nominate yourself for the Made In
India Search.
By checking this box, I verify that I have read and agree to the Terms and Conditions of the Made In
India Search, that all above information is correct, and consent to possible reference and background
checks. *
I agree
I agree to provide all necessary information relevant to the Made in India Search as required by the
organizers.*
I agree
I also agree to travel to Mumbai at my own expense for the required core committee meetings and to the
TiE Entrepreneurial Summit 2012. *
I agree
I hereby allow the organizers to publish all of the above information excluding my contact information
and that of my references. *
I agree