Please submit your nomination in one session

For any queries, write email to: awards@iitbacr.com

Nominator Details
Name Contact no. with Country code Email Id. Organisation
*    *    *    *
Designation
*
Address How well do you know the Nominee
* *
Section A: Personal Details of Nominee
Salutation First Name Middle Name Last Name
*    *
*
Date of Birth Country of present residence Countries of residence in
the past 10 years 		Gender
* * *
Phone no. with Country code Mobile no. with Country code Email id.
* * *
Nominee's fields of specialization Work Address
* * *
Academic Qualifications (in reverse chronological order)
Degree Awarded    Subject    University / Institute    Year   
* * * *
Add More Qualification
Section B: Professional Details (in reverse chronological order)
Organisation / Place of Employment    Designation    Duration (Ex. Jan 2021 - Dec 2022)
* * *
Add More Details
Scientific Contribution
Significant contributions to science and technology by the nominee based on the work done while residing in the country(ies) of residence (List up to 5, in about 500 words) *
Impact of his/her the contributions in the concerned field: Academic, Technical, Socio-economic (List up to 5, in about 500 words) *
Name the industry(ies) in which the technology(ies) has (have) been used and their impact (List up to 5) *
Citation illustrating the contributions of the nominee (in about 50 words) *
Any other additional information of relevance (optional)
Declaration
Name *
Place *
Date *


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