<p> Presents India Energy Storage Alliance (IESA) Awards 2017</p><p>Recognising “Energy Storage Tech Innovation Leader of the Year”</p><p>DESCRIPTION This award recognizes organizations that are contributing to research and development of next generation energy storage/microgrid technologies.</p><p>IMPORTANT RULES FOR PARTICIPATION 1. All questions must be answered. Incomplete forms may not be considered. You may use additional space, if required, however please ensure that you adhere to a word limit of 500 words for each question. 2. In case you don’t have an answer for any question, please write ‘NA’ for that question 3. Mandatory supporting documents are to be provided as required. Applications without mandatory supporting documents may not be considered for the Awards 4. The declaration (at the end of this form) must be signed by a senior functionary of the organization (MD/Owner/Director/Any other senior functionary with signing authority) 5. The form may be submitted by emailing the completed application to [email protected] </p><p>The completed form must reach the Awards Management by 25th December, 2016 6. Please maintain one copy of the form with you for your records. 7. If you have any questions, or require any clarifications, please contact Mr. Debi Dash at [email protected]. 8. The final eligibility of the nominees is subject to the discretion and approval of the Award management and Jury 9. Submission of this application will be deemed acceptance of the Award’s terms and conditions as available on the website : www.indiaesa.info 10. Information provided in this form will be confidential and will be used only for the limited purpose of evaluating the entry to these Awards</p><p>IESA Awards 2017 Page 1 SECTION I – COMPANY GENERAL INFORMATION</p><p>Name of the Applicant (Individual) Designation</p><p>Name of the organisation</p><p>Year of Establishment No. of Employees</p><p>Registered office address</p><p>Telephone: Contact details Email: </p><p>Company website:</p><p>SECTION II – COMPANY FINANCIAL INFORMATION</p><p>Section FY 14 FY 15 FY 16 </p><p>Total Revenue</p><p>Total EBIDTA Presents</p><p>IESA Awards 2017 Page 3 SECTION IV – INNOVATION DETAILS</p><p>1. Describe the innovation(s) and its (their) application(s). </p><p>2. What is the stage of the technology innovation(s) – lab scale, prototype stage, early commercialisation, commercially available? </p><p>3. Where has the R&D been carried out – India or abroad? If majorly abroad, describe the relevance of the product with respect to the Indian market.</p><p>4. Expound on the market disruption potential of the product. </p><p>5. Describe your product roadmap.</p><p>6. What is the techno-commercial viability of your product? </p><p>7. Where do you see your technology in 5-10 years?</p><p>8. Please provide names and a short bio of the innovator(s).</p><p>Presents</p><p>9. Please provide any other relevant information that you would like the jury to know. </p><p>10. Have you filed for a patent? If yes, please mention details below. </p><p>Patent 1 Patent 2 Patent 3</p><p>Status(Provisional/Final)</p><p>Date Awarded</p><p>Country/Region</p><p>Copyright</p><p>Innovation details Type of machine / technology used Overall capacity (Rated Power in KWh)</p><p>11. List the details of the documents provided to support your entry S No. Document Name Description of document</p><p>1</p><p>2</p><p>3</p><p>12. Does your company classify as a startup? If yes, please tell us more about the following: - How much investment have you raised and how?</p><p>IESA Awards 2017 Page 5 - Have you won any other awards? Presents</p><p>DECLARATION</p><p>I declare that the information provided in this application form is correct, accurate and pertains to my business. I agree to abide by the rules and regulations of participation.</p><p>Sign Date</p><p>Name</p><p>Designation</p><p>Company Stamp</p><p>IESA Awards 2017 Page 7 </p>