Nomination Form 2025
Uploaded by
infoNomination Form 2025
Uploaded by
infoNOMINATION FORM
(Please fill up and return this form,
duly signed and stamped,
by email to awards21@csrtimes.org
(A) Select Applicant Type:
▢Government ▢PSU ▢Corporate ▢Corporate Foundation ▢NGO ▢MSME ▢Individual
▢Start-up ▢Other _________________________________________
(B) Select Award Category
▢1. Education ▢2. Healthcare ▢3. Skill Development ▢4. Women Empowerment ▢5. Eradication of Hunger,
Poverty & Malnutrition ▢6. Livelihoods ▢7. Water Conservation and Management ▢8. Swachh Bharat
(Sanitation, Health and Hygiene) ▢9. Environment Stewardship ▢10. Rural and Infrastructure Development
▢11. Special Categories (Old Age/Specially-abled/Armed Forces, etc.) ▢12. Sustainable Development
▢13. Carbon Emission (Carbon Credit/EV) ▢14. Sports Promotion ▢15. Waste Management ▢16. CSR
Professional of the Year ▢ 17. Any Other Category (Please specify) _________________________________
(C) Basic information:
Project Title
Name of the Organisation
Company website URL
Date of incorporation
Full Address
State & Pincode
Nature of the business & its
products/services
Nomination Form - 12th National CSR Summit & CSR TIMES Awards 2025
NOMINATION FORM
(Please fill up and return this form,
duly signed and stamped,
by email to awards21@csrtimes.org
(D) Contact Details:
Head of the Organisation CSR Head Officer handling this award
Full Name
Designation
Phone
(E) Sponsor of the project:
Name of the Sponsor
Address of the Sponsor
Contact Numbers
Email Id
Website URL
(F) Any other award/s received for this project:
Nomination Form - 12th National CSR Summit & CSR TIMES Awards 2025
NOMINATION FORM
(Please fill up and return this form,
duly signed and stamped,
by email to awards21@csrtimes.org
(G) Comments of the beneficiaries of the project:
(H) Have you got the Impact Assessment done for your project through a third party?
▢ Yes ▢ No
If yes, then submit report of impact assessment, if executed by any third party for this project (in max. 200 words )
(J) Undertaking:
I/We hereby declare that all the information given above is true and correct to the best of my/our knowledge. I/we understand
that this application shall be processed by a team of the experts and placed before the jury. Additional information as
required by the jury will be furnished by me/us in a particular time frame. If required, I/we shall attend a meeting with the
Jury about my/our nomination.
(K) Checklist:
▢ Detailed Project Report attached ▢ Project Impact Assessment Report by a third party attached ▢ Testimonials of
beneficiaries attached ▢ Additional documents related to the project/nomination attached
[Please note nominations submitted with incomplete form, in respect of information sought and/or non-payment of nomination fees
will be rejected]
SIGNATURE NAME DATE
Nomination Form - 12th National CSR Summit & CSR TIMES Awards 2025