Application Form

Name of Applicant/s*
E-mail Address*
Password*
Confirm Password*
Please tick relevant box
Application Submitted by*
Category of Applicant

Individual Information Form

Name of the Candidate
Name of the Institution
Job Title
Date of Birth
Website

Social Media Page/s

Fb
twitter
google

Contact Details

Telephone (Land)
Mobile
Fax
Email

Group Information Form

Name of the Institution
Group Name
Website

Social Media Page/s

Fb
twitter
google

Contact Details

Name
Designation/ Role
Date of Birth
Mobile
Add
Name
Designation/ Role
Date of Birth
Mobile
Add(1)
Name
Designation/ Role
Date of Birth
Mobile
Add(1)(1)
Name
Designation/ Role
Date of Birth
Mobile
Add(1)(1)(1)
Name
Designation/ Role
Date of Birth
Mobile

Organization Information Form

Name of the Organization
Project Role
Registered Address
Incorporation/ Registration Date
Upload scanned copy of BR
Website

Social Media Page/s

Fb
twitter
google

Contact Details

Name of Head of the Organization
Designation
Telephone (Land)
Mobile
Fax
Email
Add organization
Name of the Organization
Project Role
Registered Address
Incorporation/ Registration Date
Upload scanned copy of BR
Website

Social Media Page/s

Fb
twitter
google

Contact Details

Name of Head of the Organization
Designation
Telephone (Land)
Mobile
Fax
Email
Add organization(1)
Name of the Organization
Project Role
Registered Address
Incorporation/ Registration Date
Upload scanned copy of BR
Website

Social Media Page/s

Fb
twitter
google

Contact Details

Name of Head of the Organization
Designation
Telephone (Land)
Mobile
Fax
Email

Product Data & Details

Name of the Product Nominated (in English)
Do you have the authority to submit this product under your name?
Short description of the product/ project (Maximum 200 words)
Detail description of the product/ project (including user impact)
Do you think your project is unique? Please explain the innovativeness of the idea (Maximum 200 words)

Product Data & Details (Cont.)

Language(s) of the Product interface
Please Specify
Category (Please Select only one category)
Does your Project/ Product provide enough interactivity to the users? (Maximum 200 Words)
If so how?

Product Data & Details (Cont.)

Platform of Product (Please tick one or more as applicable)
Web
Other (Please Specify)

Product Data & Details (Cont.)

Has your product been deployed? Please describe current status of deployment (Maximum 100 words)
If Yes, for how long?
Target group of your product
Guidelines for jurors how to navigate through your product. What features should they try, where to start, etc. (Maximum 500 Words)
URL (If online)
Installation procedure of the product (If applicable)

Login details of the product

(if required, Mention the user access information)

Username
Password

Product Logo

Logo
Comments

Product Demonstration Video


Upload a short demo video of the product (duration: 3 minutes; size: maximum 100MB)

Upload a File:
Comments

Product User Manual / Writeup

Document
Comments
Other files
I read and hereby agree to the Terms and Conditions for taking part in eSwabhimani 2017.