Bombay Chamber of Commerce and Industry

Good Corporate Citizen Award 2016-17

Application and Data Sheet

  1. Company Profile:
  1. Name and Address of the applicant :
  1. Name of the Contact Person with Designation:

Tel. Cell No.

Email:Website:

  1. Year of Establishment: ______
  1. Membership:BOMBAY CHAMBER Yes  No 
  1. Category applied for: (Pleasetick the relevant option)

Large Corporate: Banking and Finance Companies: 

(Turnover above Rs.2000 Crores-F.Y.2015-16)

Medium Corporate: Small Companies: 

(Turnover above Rs.500 to 1999Crores - F.Y.2015-16)(Turnover below Rs.500Crores - F.Y.2015-16)

  1. Participation: Application Fees:

Members: 1. Large Corporate:Rs. 3000/-

2. Medium Corporate & Banking and Finance Companies:2000/-

Non- Members: 1.Large Corporate:Rs. 3500/-

2. Medium Corporate & Banking and Finance Companies: 2500/-

Small Companies: No Fees for Members as well as Non-members

Mode of Payment: Cheque DD NEFT RTGS Cash 

  1. Business Performance: (Please attach your company’s Annual Report for last 3 years)

Years / Total Revenue / Percentage increase / Profit Before Tax / Profit After Tax / Percentage increase
2013-2014
2014-2015
2015-2016
2016-2017
  1. Performance in Industrial Relations:
  1. Man-days lost due to: ______Any Strike  Cessation of Work: 
  1. Do you have any workplace policy relating to industrial relations?

Yes No 

If yes, attach a copy of policy.

  1. Environment, Safety and Occupational Health:
  1. Do you have ESH Policy? Yes No 

If yes, attach a copy of policy.

  1. Budget allocated to ESH Activities:

Rs.______% of Total Post Tax Profit______

  1. State the Safety Health and Environment related standard followed by the company

______

  1. List specific activities for the following areas, if any:
  1. Energy Conservation:
  1. Water conservation/Recycle/Reuse:
  1. Reduction in Green House Gas Emissions:
  1. Usage of Renewable Sources of Energy:
  1. Solid Waste Management:
  1. Management of Hazardous Waste:
  1. E-Waste Management:
  1. Usage of Paper:
  1. Employee Welfare:
  1. Do you have any employee welfare Policy? Yes  No 

If yes, attach a copy of policy.

  1. Gender Balance
  1. Affirmative Action Policy - If yes, attach
  1. Whistle Blower Policy - If yes, attach
  1. No. of Man Days lost due to Accidents
  1. Policy for Safety of Women
  1. No. of Labour related court cases
  1. List Employee / Employee Family Welfare Programmes

a.

b.

c.

d.

e.

f.

  1. Budget allocated:

Rs.______% of Total Post Tax Profit______

  1. Do you evaluate Employee satisfaction? How?

a.

b.

c.

d.

e.

  1. Specify the incentives,if any, to employees for innovative suggestions to improve productivity, safety & health and environment, etc

______

______

  1. Ethics and Consumer Satisfaction:
  1. Does the company have and follow Code of Conduct/ Code of Ethics?

Yes No  If yes, attach a copy.

  1. Means for Evaluation of Customer Satisfaction:
  1. Management of Complaints
  2. Rectification and replacement
  3. Survey and Research
  4. Any other (Pl. specify)
  1. Cases Pending with Consumer Guidance Forum / Court :

Yes  No  If yes, provide No. of Cases: ______

  1. Has the company ever been found to in noncompliance of statutory provisions regarding

Taxes LabourEnvironment Any other (Pl specify)______

  1. Composition of Board of Directors

Resident Directors: ______Independent Directors: ______Women Director______

  1. Social Investment/CSR:
  1. Do you have a Corporate Social Responsibility (CSR) Policy?

Yes  No  if yes, attach a copy of the policy.

  1. Budget allocated to CSR activities: (give latest figures)

Rs.______% of Total Profit after tax______

  1. No. of persons employed with disabilities: ______, % to total no. of employees:______
  1. List active CSR Projects with brief description in the year 2014-15:

a.

b.

c.

  1. Please write in an about 500 words why you feel your company is uniquely qualified for this award.
  1. Declaration:

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.

______

Signature

On behalf of the Organization

(Stamp/Seal)

Place: ______Name of the Authorized Signatory: ______

Date: ______Designation: ______

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