Bombay Chamber of Commerce and Industry

Bombay Chamber of Commerce and Industry CIVIC AWARDS: 2016-17 Data Sheet Social Development/Corporate Social Responsibility (CSR) Initiatives

Company Profile:

Name ……………………………………………………………………………………………………………….

Year of Establishment ……………………………………………………………………………………………………..

Business Performance

Years Total Percentage Profit Before Tax Profit After Tax Percentage Revenue increase increase 2013-2014 2014-2015 2015-2016 2016-2017

Title of Work / Programme ……………………………………………………………………………………………………………….

Name of Contact Person ………………………………………………………Designation: …………………………………

Address ……………………………………………………………………………………......

……………………………………………………………………………………………………………….

Phone No. (Off.) …………………………………………….. (Cell No.)………………………………………………

Email id ………………………………………………………………………………………………………………

Website ………………………………………………………………………………………………………………

Membership: BOMBAY CHAMBER Yes  No 

Participation: Application Fees: Members: Rs. 3000/- Per application (inclusive of Service tax) Non Members: Rs. 3500/- Per Application (inclusive of Service tax) Any organization can apply for more than one category

Civic Awards 2015-16 Page 1 Mode of Payment: Cheque  DD  NEFT  RTGS  Cash  Activities:

1. Do you have a CSR/sustainability policy? Yes No 

2. Is there a separate budget for CSR? Yes  No 

3. The percentage of the company’s net profit is invested in the CSR initiatives  Less than 2 %  Between 2% to 5%

 More than 5%  Any other

4. Which among the following would be the main department/function responsible for Social Development Initiative in your company (Tick options as applicable)  A Separate CSR/Sustainability Department  Within the Human Resources Department  Within Corporate Relations/PR Department  Company Foundation/Trust initiated  Any other (Please specify) ……………………………………………………………………………………………….

5. Tick on the suitable ways through which you promote Social Development initiatives  Through financial/non-financial support to NGOs/Civil Society Organizations  Through Public Private Partnerships  Through Company Foundation  Philanthropy  Self initiatives and projects like awareness campaigns  Employee Volunteering  Other (Please specify) ………………………………………………………………………………………………………

6. Choose any priority areas for Social Development initiatives of your company:  Health ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………...

 Education ………………………………………………………..……………………………………………………………. ………………………………………………………………………………………………………………………

 Employment Generation/Livelihood Support ………………………………………………………………………………………………………………………

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 Empowerment of women /Youth and Support …………………………………………………. …………………………………………………………………..

………………………………………………………………………………… ……………………………………

 Development and Protection of Children ………………………………………………………………………………… ……………………………………

………………………………………………………………………………………………………………………

 Special Education and Vocational training & Placement of Differently abled Children

………………………………………………………………………………… ……………………………………

………………………………………………………………………………………………………………………

 Any Other Pl Specify

………………………………………………………………………………… ……………………………………

………………………………………………………………………………………………………………………

7. What type of support is provided under CSR? (Please tick the relevant)  Project support  Sharing of skills/ core competency

 Material Aid  Financial Aid  Employee Volunteering

8. If you have made any donations or provided support in the last financial year, indicate from the following areas . No donations made ………………………………………………………………………………………………………

. Any other (Eradication of poverty and hunger, Disaster Relief, State /Central Govt. funds, Differently challenged children, Vocational training for youth and placement, Women Empowerment & Children Development (Early childhood education, reduction of child mortality and maternal health), Education (including primary education), Health etc. please specify)

…………………………………………………………………………………………… ………………………………………..

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9. Is there a special team for planning and monitoring CSR Initiatives? Yes  No 

10. Overall Community Empowerment and Community development activities are measured through  Qualitative indicators  Quantitative indicators  Both  None 11. Does your organization promote employee volunteering? Yes  No 

11.1 If yes, how is employee volunteering activities promoted? (Tick as many as applicable)  Have a formal program on employee volunteering  A team of employees decide informally and take up the volunteering activities  Employees are encouraged to volunteer with a select group of NGOs  Formal training on volunteering is given to the employees  External consultants/NGOs are appointed to facilitate the process of employee volunteering  Any other (please specify)………………………………………………………………………………………………

12. On an average how many employees participate in volunteering activities per year?  <10  10-50  51-100  > 100

13. Do you give any incentive to employees to encourage volunteering?  Exemptions from attending office (Volunteering is allowed during office hours)  Promotions  Increments  Any other (please specify)

14. Project Implementation partnership with  Civil Society Organization  NGO  Company Trust/foundation  internal team for implementation

. Name of the Organization ………………………………………………………………………………………......

15. Please attach any other significant facts in support of your application in separate sheets.

16. Declaration:

I/We certify that the information given herein and attached herewith is correct and complete. I/We hereby agree to abide by the decision of the Panel of Judges.

……………………………………………… Signature On behalf of the Organization

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Place ………………………… Name of the Authorized Signatory …………………………………………………………

Date ………………………… Designation ………………………………………………………………

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