Nomination form for Award- 14/2/2022

Name of the Award : _____________________________________________

1. Name of the Organization & Year of

Establishment

2. Type of Organization :Small/ Medium

/ Large

3. Address

4. Telephone No.

Fax No.
5. Email address

Website address
9 Contact Detail of applicant

10 Company Turnover (last Three Years)

11 Exports Turnover (last Three Years)

Applicable for Export award

12 Names of Exporting Country

Applicable for Export award

Last date of submission of Nomination 31st December 2021

Pesticides Manufacturers & Formulators Association of India

D/516 Crystal Plaza , Andheri Link Road, Andheri (W) ,Mumbai-400053. India
T:+91-22-26734845 /46 F:+91-22-26734847 E: pmfai@bom4.vsnl.net.in W: www.pmfai.org
13 Efforts made to Increase exports.
Applicable for Export award

17 Member of any Association/trade

body

19 Major Achievement & Accolades

Received if any

20 Summary Justifying for the Award not

more than 500 words.

I _____________________________ (Name in Full),__________________________(Designation)

hereby confirm having read & understood the Rules & Regulations by the PMFAI for the Awards, and
will abide to the same. I also confirm the information provided by me in the Application form is correct
to the best of my knowledge.

Signature Date

Seal

Note:
1. An entry form will be considered complete and valid, only if the following are duly completed
and couriered to the PMFAI Office
a. (FOR EXPORT CATEGORY AWARD: Certificate from CA for Turnover and Export Turnover or
Bank Certificate stating the export turnover or CA Certificate certifying the export turnover for
crop protection chemicals only
b. Other relevant supporting documents or information deemed appropriate
c. Duly filled Nomination form along with the enclosures as prescribed in the Nomination Form
2. Please read & Regulations before applying to the Award Nomination.
3. Use Separate sheet to fill the details if required.

Last date of submission of Nomination 31st December 2021

Pesticides Manufacturers & Formulators Association of India

D/516 Crystal Plaza , Andheri Link Road, Andheri (W) ,Mumbai-400053. India
T:+91-22-26734845 /46 F:+91-22-26734847 E: pmfai@bom4.vsnl.net.in W: www.pmfai.org