Company name * Do you meet the GDC’s eligibility criteria? * Yes No Primary contact – first name * Primary contact – last name * Primary contact – email address * Country(ies) of operation, i.e., where you sell products to last mile consumers * Category(ies) of products sold * Solar lights and home systems Cookstoves and cookers Fuels Domestic appliances, e.g., fans, TVs, radios Productive use of energy appliances, e.g., solar water pumps, egg incubators, solar drip irrigation, solar mills Agriculture inputs, e.g., fertilisers, seeds WASH products, e.g., water filters, water treatment products, sanitary products Health products, e.g., medicines, contraceptives Nutrition products, e.g., fortified foods, vitamins Consumer electronics, e.g., mobile phones, smart phones Other If other, please specify: If you sell services, tick category(ies) that apply Crop insurance Healthcare Waste removal Software Financial Other If other, please specify: Distribution channels used * Direct to consumers and/or through sales agents (whether employees or micro entrepreneurs) Retailers Community channels (e.g., schools, non-government organisations or churches) E-commerce Other If other, please specify: Annual revenue in USD * Start-up Below USD 100,000 USD 100,000 - 250,000 USD 250,000 - 500,000 USD 500,000 - 1million USD 1million - 2million USD 2million - 5million Above USD 5million Year in which your company started operating * How many consumers has your company reached since you started operating? * How did you calculate this number? * Is your company locally owned? i.e., citizens of the country of operation own >50% of the shares * Yes No Is your company locally led? I.e., citizens of the country of operation make up >50% of the senior leadership team or the CEO / MD is a citizen of the country of operation. *
Yes No Is your company women led? i.e., women make up >50% of the senior leadership team or the CEO / MD is a woman. * Yes No Is your company women owned? I.e., women own >50% of the shares. * Yes No Company website * Link to your company's LinkedIn Page * Do you give the GDC permission to use your company logo and website on our website? * Yes No Do you agree to the GDC code of conduct? Read here * Yes No
