Health Insurance – Rethinking Business Models& Excellence Awards 2020

Be Recognised by Industry Peers, Highlight Excellence

APPLICATION FORM(Entry closing date 31st January, 2020, Awards on 14th February, 2020, Kolkata)

Nomination Fee Rs 7500/- plus GST 18%

1. Name of the Business ________________________________________

2. Address with Phone and Fax ________________________________________

3. Name of the Head of the Organisation ________________________________________

4. Contact Person Designation and Number ________________________________________

5. GST No. __________________________________________

6. Year of Establishment ________________________________________

7. Activities ________________________________________

8. Geographical Reach ________________________________________

9. Awards/Accolades Won already ________________________________________

CATEGORIES

The Insurance Product of the Year Best use of Technology Leader of the year

Excellence in Service Innovation Business Transformation of the year Claim Leader

Excellence in Social Impact Life Time Achievement Innovative Broker/Marketing/TPA Firm

Terms and Conditions

1. Entries completed along with nomination fee to reach ASSOCHAM as per the deadline mentioned.

2. Multiple entries for participation are accepted.

3. Decision by Award Committee is final and binding on all.

4. No details on outcome of decision, Jury member contact list shall be shared at any stage. No refund claim request shall be accepted.

5. Corporate profile is a must. Audited balance sheet of the company for at least one year with people at the helm to be submitted along with the form (Web link may be shared).

6. Preference digital payment mode for fee submission

Please use separate sheet to respond only to the category being applied for, in minimum 200 words maximum 1000 words justifying the nomination.

The Insurance Product of the YearPlease list out the product(s) launched/relaunched in the year and that has impacted the business and set new high in the industry

Life Time AchievementOrganisations/ Individuals are invited to nominate Industry leader who have shown path to many in the industry and has contributed significantly

Best use of Technology

Please explain in 200+ words the usage of technology in reaching out to customers for value added services, internal process improvement OR disruptive technology usage

Business Transformation of the YearPlease explain in minimum 200 words the initiatives taken and achievements of the company for business growth, excellence in customer service, Operational improvement and Financial Management. Exception stories of usage of Social Media, New Business Model adoption may be shared.

Leader of the year

Please explain in 200+ words the initiatives taken by the individual to enhance company growth, offer value to Investors and Stake holder, decision to facilitate turnaround.Single or series of decision that has impacted company’s performance and has left an impact on the industry

Excellence in Service Innovation

Please explain in 200+ words the innovativeness of solution in extending service to end users and key stake holders. The impact innovation has made in conduct of business and in offering service to customers.

Claim LeaderPlease explain in 200+ words the innovativeness in extending service to end users and ensuring claim settlements, accuracy, approach, process management

Innovative Broker/Marketing Firm/TPAIntermediaries are invited to nominate self/peer for in innovative approach to service end consumers and to bridge the divide

Excellence in Social Impact

Please explain in 200+ words the initiative taken to reach to rural market, Special initiative taken to promote Government Benefit Schemes, Educational and Awareness Series for developing entire Eco System

Special Jury Awards

for start-ups, tech innovators, insurance intermediaries, hospitals and other value creators

I/We confirm the data provided is true to my/our knowledge and I/we have read and understood the terms and conditions of the participation.

____________________________

Signature of the Authorised Signatory

All the Cheque/draft should be drawn in favour of “ASSOCHAM Regional Office Kolkata” payable at Kolkata Or Bank Transfer to Account Number 00141110005388 IFSC Code HDFC0000014

Payment Details:

Cheque No & Date Bank Details & Branch Name Amount ( Rs) Note if any

Bank Transfer transaction No

Bank Details & Branch Name Amount ( Rs) Note if any

For further information please contact:

Kallol Ghosh – 7003581862 / 8479984112, or email: kallol.ghosh@assocham.com