SME BUSINESS UNIT
MSME WING
HEAD OFFICE, BANGALORE – 560 002
CANARA BANK BEST ENTREPRENEUR AWARD (MFG & SER)
GUIDELINES CUM APPLICATION FORM
Instructions:
 Nominations allowed from Entrepreneurs in the Micro & Small Enterprises (manufacturing &
Services) who have availed Financial Assistance from Canara Bank only
 Evaluation is based on both Personal and Organizational Achievements, hence please fill in all the
information DO NOT LEAVE BLANKS
 Please use additional attachments where necessary while filling the information required in the
application.
 Last 3 Years Balance Sheet ( If available ) to be enclosed
 Amounts in Lakhs only
 Please attach a write up of not more than 500 words covering your Growth as an Entrepreneur ,
Challenges faced, Achievements, Future Plans & why you should be considered for the Award
 The winners of the Award will be selected by a Committee of Executives of the Bank & outside
Experts. The decision of the Committee will be Final.
Information provided by the applicant in the Application will be maintained as strictly confidential
PART I- PERSONAL
Name ( Please attach your Resume )
Date of Birth
Residential Address with Phone/ Email
Educational Qualification
PART II – ORGANISATION
1
Name and Address of the
Organization with Phone /Mobile/
E-mail/Website if any
2
3
Date of Establishment
Are you a first generation
Entrepreneur ( Tick )
4
5
6
7
Yes
No
Vision/Mission Statement, If any
(Maximum – 50 Words)
SSI/ Registration number with
date
( If applicable )
Constitution : Proprietorship/
Partnership / Private Ltd / Public
Ltd / others ( specify )
a) Nature of the Industry/Activity
( Please give full details )
b) Major Products/Services
8
9
Details of Existing borrowings / Banking arrangements
Name of Fin. Insts/ Banks/ Lenders Nature of
Sanctioned Amount
from whom the unit has availed
assistance /
(Rs in Lakhs)
loan / credit limit/s
loan / limit
availed
Operational details of the Organization for the past 3 years:
Year
Turnover
Net Profit after
Spending for
( Rs in Lakhs ) taxes
R&D
( Rs in Lakhs )
( Rs in Lakhs )
2011-12
2012-13
2013-14
2
Have there been any
defaults in repayment? If
yes, please give details
and causes
No of
Employees
Original investment
in Plant &Machinery
/ Equipments
(Rs in Lakhs)
10
Total No of Plants
(Manufacturing Sector)
OR Delivery
Centres(Service Units)
FY 12-13
FY 13-14
Location of plants
(Manufacturing)/
Delivery Centres
(Service Units)
FY 12-13
FY 13-14
Total Installed Capacity
of all plants and units
of measurement p.a./
Distribution network
FY 12-13
FY 13-14
Production in units of
all plants p.a./No of
employees
FY 12-13
FY 13-14
11
Investment in Plant and Machinery/Equipment(Excluding Land and Building)- Tick Applicable
12
Manufacturing:
Services:
a) Upto Rs.25 lakhs
a) Upto Rs. 10 Lakhs.
b) More than Rs.25 lakhs and upto Rs.5 Crores
b) More than Rs.10 Lakhs and upto Rs.2 crores
c) More than Rs.5 Crores and upto Rs.10 Crores c) More than Rs.10 Crores and upto Rs. 5 Crores
Operational details of the Organization for the past 3 years:
Year
Export - Direct
( Rs in Lakhs )
Export (Through Export Houses)
( Rs in Lakhs )
2011-12
2012-13
2013-14
13
14
15
Arrears of Income Tax/Sales
Tax/VAT/Other statutory dues if any
(Give Full Details)
Steps undertaken by you to
continuously improve and adopt your
business – products to the market
requirement
(Each in not more than 100 Words)
Environment
Pollution Control
Preservation
Measures ( give
details )
Energy Efficiency/
Equipments/
Machinery
Technology
Improvement in
P&M
Improvement in method
of Processing/Services
Implemented /
Not implemented
If implemented , details
(In less than 100 Words)
Implemented /
Not implemented
If implemented , details
(In less than 100 Words)
Others
16
Energy Conversation Measures - Implemented
Use of alternate source of Energy
Details not more than 50 Words
Energy conservation Measures
Details not more than 50 Words
3
17
18
19
20
Employees
Welfare
Measures
ESI, Health
Insurance
Training
Reward for
Suggestion
Innovations undertaken/ innovative
technologies adopted
Research & Development Initiatives
Details in maximum of 100 Words
Details in maximum of 100 Words
Write up about yourself/your Details in not more than 200 Words
Company and why you consider
yourself eligible for the award
PART III
Declaration
I hereby declare that the above information given by me is correct and I will abide by the rules and
regulations of this contest.
There are no statutory violations committed by me or the organization and no legal proceedings pending
against me or the organization in this regard. I confirm having cleared all the statutory dues.
Date:
Signature
:
Place:
Name/ Seal of the Firm
:
4