The Bharat Ratna is the highest civilian award of the Republic of India. Instituted in 1954, the award is conferred "in recognition of exceptional service/performance of the highest order", without distinction of race, occupation, position, or sex. The award was originally limited to achievements in the arts, literature, science, and public services, but the government expanded the criteria to include "any field of human endeavour" in December 2011. The recommendations for the Bharat Ratna are made by the Prime Minister to the President, with a maximum of three nominees being awarded per year. Recipients receive a Sanad (certificate) signed by the President and a peepal-leaf-shaped medallion; there is no monetary grant associated with the award. Bharat Ratna recipients rank seventh in the Indian order of precedence.