Permanent Address *

Address for Communication *

Mobile No *

Email ID *

Current Professional/ Employment Status *

Name of Company or registered entity *

Date of registration/incorporation(if applicable) *

Category of Technology/ Innovation *

Team Member Name *

Education Qualification *

No of Years experience *

Email id of Team member *

Team Member Mobile Number

Title of your Technology proposal for Incubation *

Brief Description of the Product/Services/Technology business you plan to incubate *

Stage of development of the technology *

Possible application of the technology *

Identified potential competitors (Details on competitive edge for your technology/service) *

Target market (brief on market for your products / services specifying nations / regions) *

Estimated project costs (provide detailed breakup for capital expenses in separate sheet) *

Description of the R&D efforts and other technological inputs you hope to resource from any affiliated colleges (Please also indicate names of faculty member(s), dept./centers of the Institute you plan to associate and equipments facilities to be used) *

Have you estimated and identified your funding needs/ source *
Yes
if yes, provide details)
No

Have you estimated and identified your funding needs/ source *

Please identify the services expected from Atal Incubation Center of (1If you want any other services not included in the above list mention here) *
Workspaces – LAB Suites
Requirement _________________sq.ft. (150 sq.ft. 250 sq.ft.)
Co-Working Spaces
Dedicated office space
Medtech Facility
Central instrumentation facility

Any other proposal details related to your Proposal *

Declaration *

The declaration and facts in the application are true and best to our knowledge and nothing material has been concealed.

Copy of the Certificate of Incorporation (PAN Card, GST details). *

MoA & AoA of Applicant Company (If Any)

Business Plan *

Resume of the Applicant and other members of the team & valid identify proof *

One Page detailed description of the problem you are solving *

Member PAN, Identification details *

Photograph *