* Separate Form Is to Be Filled for Each Applying Unit

ENTRY FORM* *Separate form is to be filled for each applying unit.

I. COMPANY INFORMATION Company Name Head Office Mailing Address City State Pin Code Website Landline Industry Type (Process/ Discrete/ Mix) Product Range

No. of units

Location of units

II. UNIT INFORMATION Unit Name Mailing Address

City State Pin Code Website Landline Plant Area (sq m) Plant Built-up Area (sq m) Products Manufactured Sales Turnover

Management

No. of employees Staff Workmen - permanent

Workmen – temporary/ contract

Major Customers

Certification Since (year) List Certifications received (e.g. ISO)/ corresponding years

Operational OE Practice Started (year) Excellence practices implemented/ for how

Weekly off day(s) 1

Plant closure dates 1 Public holidays

Any other information

III. CONTACT DETAILS

Contact person for correspondence Name Designation Mobile Landline Email

Highest Ranking Officer Name Designation Mobile Landline Email

Finance Contact (To whom invoices & other financial matters may be addressed) Name Designation Phone Mobile Email

IV. TRAVEL INFORMATION

1 Nearest Airport 2 Travelling time from Airport to Plant 3 Suggested Hotels for Assessor(s) to stay Name Address email Telephone 4 Travelling time from Airport to Hotel 5 Travelling time from Hotel to Plant 6 Weekly off day(s) 7 Plant closure dates 8 Public holidays

V. PREVENTING CONFLICT OF INTEREST

If your organization/ unit has been using the services of any individual Consultant or Consulting Firm to support your Organizational Excellence efforts, kindly fill-in the following information:

No. Name of the Consultant Name of the Consulting Firm

This is to prevent appointment of these persons/ firms as assessors.

VI. DECLARATION

 This entry application represents the organization’s decision to participate in the complete 2 KMAX Awards process for the year_____.  We also understand that if our entry is accepted, we shall pay an Application Fee. Once 2 we clear stage 1 (off-site data analysis), we shall pay the relevant On-site Assessment Fee & organise/ facilitate a site visit for the assessment team.  On behalf of my organization, we agree to abide by the rules of KMAX awards and accept the decisions of Kaizen Institute India Pvt. Ltd. as final.  We confirm that all information in the application form is correct.  We accept the time table, the Non-disclosure Agreement (Confidentiality Agreement) and the cost & fee structure.

Signature of Authorizing Official Date

Please email the duly completed Entry Form to:

Ms. Aarti Mahajan [email protected]

KMAX Secretariat Kaizen Institute India Pvt. Ltd., Office No. 1 A, Second floor Sunshree Woods Commercial Complex, NIBM Road, Kondhwa – 411048, Pune