<p> Bombay Chamber of Commerce and Industry CIVIC AWARDS: 2016-17 Data Sheet Social Development/Corporate Social Responsibility (CSR) Initiatives </p><p>Company Profile: </p><p>Name ……………………………………………………………………………………………………………….</p><p>Year of Establishment ……………………………………………………………………………………………………..</p><p>Business Performance </p><p>Years Total Percentage Profit Before Tax Profit After Tax Percentage Revenue increase increase 2013-2014 2014-2015 2015-2016 2016-2017</p><p>Title of Work / Programme ……………………………………………………………………………………………………………….</p><p>Name of Contact Person ………………………………………………………Designation: …………………………………</p><p>Address ……………………………………………………………………………………...... </p><p>……………………………………………………………………………………………………………….</p><p>Phone No. (Off.) …………………………………………….. (Cell No.)………………………………………………</p><p>Email id ………………………………………………………………………………………………………………</p><p>Website ………………………………………………………………………………………………………………</p><p>Membership: BOMBAY CHAMBER Yes  No </p><p>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</p><p>Civic Awards 2015-16 Page 1 Mode of Payment: Cheque  DD  NEFT  RTGS  Cash  Activities:</p><p>1. Do you have a CSR/sustainability policy? Yes No </p><p>2. Is there a separate budget for CSR? Yes  No </p><p>3. The percentage of the company’s net profit is invested in the CSR initiatives  Less than 2 %  Between 2% to 5%</p><p> More than 5%  Any other</p><p>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) ……………………………………………………………………………………………….</p><p>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) ………………………………………………………………………………………………………</p><p>6. Choose any priority areas for Social Development initiatives of your company:  Health ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………...</p><p> Education ………………………………………………………..……………………………………………………………. ………………………………………………………………………………………………………………………</p><p> Employment Generation/Livelihood Support ………………………………………………………………………………………………………………………</p><p>Civic Awards 2015-16 Page 2 ……………………………………………………………………………………………………………………...</p><p> Empowerment of women /Youth and Support …………………………………………………. …………………………………………………………………..</p><p>………………………………………………………………………………… ……………………………………</p><p> Development and Protection of Children ………………………………………………………………………………… ……………………………………</p><p>………………………………………………………………………………………………………………………</p><p> Special Education and Vocational training & Placement of Differently abled Children</p><p>………………………………………………………………………………… ……………………………………</p><p>………………………………………………………………………………………………………………………</p><p> Any Other Pl Specify </p><p>………………………………………………………………………………… ……………………………………</p><p>………………………………………………………………………………………………………………………</p><p>7. What type of support is provided under CSR? (Please tick the relevant)  Project support  Sharing of skills/ core competency</p><p> Material Aid  Financial Aid  Employee Volunteering</p><p>8. If you have made any donations or provided support in the last financial year, indicate from the following areas . No donations made ………………………………………………………………………………………………………</p><p>. 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) </p><p>…………………………………………………………………………………………… ………………………………………..</p><p>Civic Awards 2015-16 Page 3 …………………………………………………………………………………………… ………………………………………..</p><p>9. Is there a special team for planning and monitoring CSR Initiatives? Yes  No </p><p>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 </p><p>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)………………………………………………………………………………………………</p><p>12. On an average how many employees participate in volunteering activities per year?  <10  10-50  51-100  > 100</p><p>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)</p><p>14. Project Implementation partnership with  Civil Society Organization  NGO  Company Trust/foundation  internal team for implementation </p><p>. Name of the Organization ………………………………………………………………………………………...... </p><p>15. Please attach any other significant facts in support of your application in separate sheets.</p><p>16. Declaration:</p><p>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.</p><p>……………………………………………… Signature On behalf of the Organization</p><p>Civic Awards 2015-16 Page 4 (Stamp/Seal)</p><p>Place ………………………… Name of the Authorized Signatory …………………………………………………………</p><p>Date ………………………… Designation ………………………………………………………………</p><p>Civic Awards 2015-16 Page 5</p>