<p> ENTRY FORM* *Separate form is to be filled for each applying unit.</p><p>I. COMPANY INFORMATION Company Name Head Office Mailing Address City State Pin Code Website Landline Industry Type (Process/ Discrete/ Mix) Product Range</p><p>No. of units</p><p>Location of units</p><p>II. UNIT INFORMATION Unit Name Mailing Address</p><p>City State Pin Code Website Landline Plant Area (sq m) Plant Built-up Area (sq m) Products Manufactured Sales Turnover</p><p>Management</p><p>No. of employees Staff Workmen - permanent</p><p>Workmen – temporary/ contract</p><p>Major Customers</p><p>Certification Since (year) List Certifications received (e.g. ISO)/ corresponding years</p><p>Operational OE Practice Started (year) Excellence practices implemented/ for how </p><p> long?</p><p>Weekly off day(s) 1</p><p>Plant closure dates 1 Public holidays</p><p>Any other information</p><p>III. CONTACT DETAILS</p><p>Contact person for correspondence Name Designation Mobile Landline Email</p><p>Highest Ranking Officer Name Designation Mobile Landline Email</p><p>Finance Contact (To whom invoices & other financial matters may be addressed) Name Designation Phone Mobile Email</p><p>IV. TRAVEL INFORMATION</p><p>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</p><p>V. PREVENTING CONFLICT OF INTEREST</p><p>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:</p><p>No. Name of the Consultant Name of the Consulting Firm</p><p>This is to prevent appointment of these persons/ firms as assessors.</p><p>VI. DECLARATION</p><p> 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.</p><p>Signature of Authorizing Official Date </p><p>Please email the duly completed Entry Form to:</p><p>Ms. Aarti Mahajan [email protected] </p><p>KMAX Secretariat Kaizen Institute India Pvt. Ltd., Office No. 1 A, Second floor Sunshree Woods Commercial Complex, NIBM Road, Kondhwa – 411048, Pune</p><p>33</p>