NDBI - INCUBATION APPLICATION FORM Please read this before filling in/submitting the application A note to the applicant

: Disclaimer: (Don't remove or delete this portion of the application in whichever form you submit the same) Every professional effort would be made by NDBI to treat and handle this information provided here as confidential. However, by signing and applying to NDBI for incubation assistance on this application form, you agree not to make any claim or demand compensation unconditionally in any form, at any point of time, now or any time in future, on the information / technology details provided by you here as trade secret or proprietary intellectual property. This information is required by NDBI to assess the candidature for the purpose of providing incubation services. Further NDBI does not guarantee acceptance of your proposal until and unless the selection process is over and NDBI has the right to reject any proposal without assigning any reason what so ever. NDBI will not pay any compensation to you in any form for the delay in communicating the decision or rejecting the proposal at its own discretion. 1. Name of the Applicant -1: 1.1 Date of Birth: 1.2 Name of the Applicant -2: 1.3 Date of Birth: 2. Name of Company: 3. Permanent Address: Email: Phone: Mobile:

4. Educational Qualification: (from highest qualification to l0th grade) (Details of Board/Institution/University/Area of Specialization/Year of graduation) 5. Professional Experience: Company Details: Nature of Business: a. Services _______ b. Product ___________

Employee Full-time 3. Please submit a brief business plan for the company in separate sheet: . Co Founders / Partners 2. More than 5 yrs. the nature and years of expertise: (Individual resumes of each member may also be attached) 12. Please submit an estimated and identified seed funding needs/source (if any): 14. Less than a year b.1 Lead members of the team: 1. Mentors / Others 9. 8. Briefly describe your business model (Attach separate sheet. 2.2 Number of employees that will be resident (if applicable): 1. 7. Less than 5 years c. Specify if there is any requirement for machinery or capital item for starting the venture: 15. Co Founders / Partners Employee Full-time Employee Part-time Mentors / Others * Important 10. 3. Service expected from NDBI: 9. Employee Part-time 4. Write a one page State of purpose on why you want to become an entrepreneur: 11. Any past experience which is going to help in this new venture: 13. Other _______ 6. if required): 6.1 How long have you been in business? a.c. Details of your Team: 9. 4. Legal entity sought: Proprietorship / Partnership / Pvt Ltd / LLP etc. Applicant’s or team members’ previous business experience (if any).

2 Organization/ Designation 23. verification will be done after completion of the selection process) 23. Declaration: The information that I/we have provided is correct. Any projected export market for your products / services (Yes/No) please specify nation/region: 20. References: (Give two references here.1 Name of the Reference: 24.4 Phone/ mobile : 24. Product/Service Details: 18. Name of the Reference: 23.1. I have read and understood and accepted the terms and conditions set forth in the disclaimer in the beginning of this application.3 Address 24. Any research or survey conducted to validate the assumption (specify if any): 21.2 Organization/ Designation 24. You learnt about NDBI through newspaper/magazine/internet/blogs/friends/any other: 23. Describe your target market and its potential: 18.4 Phone / mobile: email: email: 25.1 Please give a brief outline of product/service details 19. Applicants Signature Date Place: . Any requirement to go global for producing the products or offering your services (Yes/No): 22. Briefly describe the methods and results of any market survey conducted so far: 17.3 Address 23.16.

Ahmedabad – 380007 Tel. Paldi.edu or printed and filled copy may be sent by courier or post to The Chief Executive Officer National Design Business Incubator NID.Please check whether you have filled in all the details and attached all the relevant information as described / required here: The completed application with all enclosure may be emailed to ceo. +91-79-2662 3692 X 5002 .ndbi@nid.