1.  Name of the writer being recommended: …………………………………………………………………

                                                                   Last                First                  Middle

 2.  Mother tongue of the writer: ……………………………………………………………………………………

 3.  Name of the Book

                        (in Roman transliteration): …………………………………………………………………

                        (in Indian Script): ………………………………………………………………………………

                        Whether Original or Translation Work ………………………………………………

 4.  Language in which the book is written ……………………………………………………………………

 5.  Year of Publication (must be during the last six calendar years

                        Jan 2000 to Dec 2005):  ……………………………………………………

6. Name and address of the Publisher: ……………………………………………………………………

7.  Category to which the book belongs: (Please tick one or more, as the case may be)

[] a. Literature (Fiction, Drama, Memories, Travelogues, Essays and Poetry)

[] b. Fine Arts and Humanities

[] c. Social Science

[] d. Science and Technology

[] e. Any other (Please specify): …………………………………………………………

 8.  Special merits of the book being recommended:

 9.  Special merits of the writer for considering him/her for the award:

 10.  Any other information that will help evaluating the book for the award:

                                                                                    Signature: ………………………

                                                              Name of the expert making the Recommendation

                                                                                    Address or Seal:

Note: Please send a copy of the book along with the bill for reimbursement.