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Application of Entrepreneur/ Incubatee (Appendix I

)

1.

Applicant Information
A
Applicant (entrepreneur) name
B
Age
C
Educational Qualifications
D
Postal Address
E
Telephone/mobile
F
Fax:
G
Email:
H
Website (if any)
I
Current professional /employment status

2
Company Information
A
Have you registered a company , give details
B
Name of applicant company/firm
C
Location from which company is operating
D
Relationship with the Business Incubator/ Host
Institute
E

Manufacturing/
Services
F
Rs ____________
Investment in plant and machinery (For lakhs
manufacturing
sector)/
Investment
in
equipment (For services sector)
G
Micro/Small/
Company type: Definitions are given in
Medium
http://www.dcmsme.gov.in/ssiindia/defination_
msme.htm
Company sector

3 Project Information A Details of proposed idea/ innovation A1 Title of the technology/innovation A2 Category of technology/ innovation (specify process/ product/ new application / other) A3 If the idea involves use of existing intellectual property. give details of the owner of the same and arrangements of sourcing the innovation and terms of its commercialization A4 Specify the potential areas of application in industry/market A5 Specify newness/ uniqueness of the innovation (better performance/ new features/ improvements) A6 What is already available in market? What is the market potential? .org/wiki/Technology_Readine ss_Level) B3 Specify the time period in months required for innovation to be completely developed for field testing / ready for intended end-user? C Financial requirements C1 Annexure 1 Do you have a business plan for taking (attach business innovation from lab to market? plan in your own format) C2 What level of funding is required for making Rs ____________ . What value it would add in market B Current Development Status of innovation B1 What is the current development status of the innovation / product or service offerings? (Whether still an idea or ready to launch).wikipedia. B2 Technology readiness level (as per http://en.

Date and Place: Signature of the applicant 6 Recommendations of the forwarding organization: Has the application been screened and evaluated at local level.innovation market ready? Requested under the MoMSME scheme C3 Please give activity wise break-up (Activities Annexure 2 include design/prototype development/ lab/bench scale production/professional services/hiring staff/ trials/test marketing/miscellaneous) 4 Other Related Information A Are there any team members/partner and mentors/guides in your innovative project. complete and best to my knowledge. Give details. Date and Place: Signature of the Head of organization with seal .………………………………. hereby certify that the information furnished in the application form from Item I-III is true. If so give name and complete contact address with phone and e-mail) B Information on Patents filed/granted (if any) C Any awards or recognition related to the innovation D Please include any further information that you wish to communicate to us to help us in judging your application 5 Other I.

Annexure 1: Business plan for taking innovation from lab to market Project title .

Annexure 2: Likely expenditure – Cost to the Incubator (suggestive. 3. IPR consultancy. 7. 4. etc. No. 6. accommodation charges. 2. you may add items) Project title Sl. Items Technology fee (design. Fax. lab testing. Computer facility. 1. Machinery hiring or leasing from outside Guidance fee for mentors/handholding persons. 5. prototyping. Electricity. test production etc Test Marketing Telephone. etc Miscellaneous TOTAL Total funds requested under MoMSME Scheme Funds to be arranged by the entrepreneur/incubate Percentage of project cost Amount . Hiring etc.

(15% for micro and 25% for small and medium enterprises) o MoMSME will require typical government reporting requirements. Receipts and documentary evidence of expenditure will be asked.25 lakhs).Notes: 1) Purpose of this program:  MoMSME is trying to help technology start-ups through technology business incubators by providing some financial assistance. Requirements from the entrepreneur: o The entrepreneur/ company has to invest at least 15-25% of the project cost.   The money will be routed through Business Incubator (MSME). . The money shall be made available as a grant. we expect that the overall budget will be Rs 6. While the categories and numbers are not expected to be rigid.25 lakhs. 2) Summary of MoMSME instructions:  The MSME instructions indicate the following structure. they are expected to provide a maximum of Rs 4-8 lakhs per entrepreneur (typically. Reporting will have to be done to Business Incubator (MSME).  Business Incubator (MSME) has signed up for this program with the primary goals of helping students to take their ideas to the level of a start-up. o The company is required to sign an agreement with Business Incubator (MSME) for the same. Typically. Rs 6.

. o Business Incubator (MSME) and MoMSME will list/publicize the company amongst grant awardee of “MoMSME Support Grant for Technology Entrepreneurship”. o Business Incubator (MSME) will list the company as its ”incubatee” and extend privileges defined for incubates which shall be announced from time to time at the Business Incubator (MSME) website.o The incubatee may be requested to present their case in front of a review/ monitoring committee.