RESEARCH EXCELLENCE AND ACADEMIC AWARD 2019

"REAA-2019"

APPLICATION FORM - INDUSTRY

Please complete all items in the application form. Attach documents/ photographs/press cuttings etc.

for support as relevant or necessary.

Name of the Industry

Contact Person

Address

Ownership and Management (Public/Private)

E-mail ID

Numbers of Employees

Contact Number

Industry Type

Year of Establishment

Certification details

S. No

Certification

Year of certification

Certified by

























Provide details on :

  • Social/ Community Initiatives.
  • Extended Manufacturer Responsibility .
  • Efforts towards achievements.
  • List any awards that your company has received over the past two years.
  • Provide List of all enclosures /attachments.

Declaration

I/ We herewith declare that the information furnished hereinabove is true to the best of my knowledge
and belief. I/We understand that in case of submission of false information my/our application would
become liable to be cancelled and the award obtained based on the false information would be
withdrawn by CSERD.