1 Type of Organization A: S.No Particulars

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S.

No Particulars

1 Type of Organization
a Individual

b Non-Profit Institution / CSR Initiatives Organizations


c Other
2 Details of Organization/ Individual
a Name of Organization/ Individual
b Address
c Mobile N o.
d Email ID
e Identity Proof (PAN, AADHAAR, VOTER ID, OTHER)
3 Areas in which the applicant is interested in providing services (select areas of interest)
a Motivation programmes for entrepreneurs

b Knowledge support for MSMEs


c Market Access Initiatives
d Financial Delivery Services
e Technology Services
f Legal services, Policy & Governance
g Infrastructure/ Common Services/ Access to Resources

h Other services provided for creating supportive


ecosystem for MSME sector
4 Past experience in the above selected areas
a Motivation programmes for entrepreneurs

b Knowledge support for MSMEs

c Market Access Initiatives

d Financial Delivery Services

e Technology Services

f Legal services, Policy & Governance

g Infrastructure/ Common Services/ Access to Resources


h Other services provided for creating supportive
ecosystem for MSME sector
5 Relevant experience of working with Central/ State Govts.

a Details of assignments done for Central/ State Govt.


Department
Details Documents to be attached

Mention details here Resume of the applicant clearly


indicating total experience, experience
in MSME sector, and educational
details
Mention details here Certificate of Registeration
Mention details here Certificate of Registeration

Mention details here


Mention details here
Mention details here
Mention details here
Mention details here
n providing services (select areas of interest)

s
Total no. of programmes organized/ conducted Supporting document clearly
and field in which these programmes have been indicating experience in organizing/
organized/ conducted conducting motivational programmes
Area in which knowledge support is provided for Supporting document indicating
for entrepreneurs
MSME development experience in providing knowledge
Type of initiatives taken to provide access to Supporting document
support for MSME indicating
development
market experience in providing market access
to entrepreneurs
Type of initiatives taken in providing financial Supporting document indicating type
delivery services to entrepeneurs of initiatives taken in providing
financial delivery services to
Area in which technology support is provided or Supporting document indicating the
entrepeneurs
any new technology developed for MSME sector areas in which technology support is
provided or any new technology
Types of services provided for MSME Supporting document indicating
developed for MSME sector
development various type of services provided for
MSME development
Details of resources (manpower, plant & Supporting document indicating
machinery, equipments, etc.) details of resources (manpower, plant
& machinery, equipments, etc.)
Mention any other details/ experience related to Supporting document
MSME sector
al/ State Govts.

Mention details of completed and on-going Supporting documents


assignments

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