Application type* --------- Pre-Incubation Incubation

Title*

Photo

First name*

Surname*

Date of birth*

Aadhar id*

Mobile no*

Email*

Address*

NAME OF PROJECT/ COMPANY*

CATEGORY OF IDEA* --------- Agribusiness and Agri processing Health and Nutrition Fintech Bio and Nano-Technology Information and Communication Technology Marketing and Communication Aviation and Space Science Business and Professional Services Green and ecological business Transport and logistics Others

STAGE OF INNOVATION* --------- Idea phase Research and development Prototype phase Start-up Market -phase Scaling-up phase Please describe how advanced your innovation with regards to its maturity

Description of innovation* Please describe your innovation: (Kindly limit this to 500 words. Feel free to attach additional sheets if you need to provide more details) we ensure the details shared will be confidential.

Extra Sheet for Description of Innovation

Explanation* Please describe why you think your project is innovative and how it might lead to breakthrough also, your product differentiation in comparison with similar projects that might exist? (150 words maximum)

OWNERSHIP & PARTNERSHIPS/COLLABORATION* Please describe any collaboration/partnerships involved in this innovation (include names and contact information of all collaborators). Also, please specify the ownership (failure to disclose ownership may lead to disqualification). (200-words maximum)

Business plan* Do you have a Business Plan & who is your targeted customer? If YES, please attach a copy. If NO, please describe your ideas and steps taken towards developing a Business Plan. (200 words maximum)

DO YOU HAVE ANY PATENT RELATED TO YOUR IDEA/PRODUCT IF YES THEN GIVE BRIEF DESCRIPTION (in 100 words)

I, solemnly declare that the above description provided by me is true and accurate. I fully understand that any misrepresentation may lead to legal consequences.

Date*

Place*

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