IT UPVAN

(Registered Society under Shreetron India Ltd, A nodal agency of Govt. of Uttar Pradesh)

Application Form

A) Venture Profile:

Company Name No. of No. of

Company Website Address
Promoters Employees

Mailing Address:

City/State: Mobile No.:

Zip Code: Email id:

Is your venture… Existing Startup Yet to be formed

Legal Status: Proprietorship Partnership firm Pvt Ltd. LLP No status

Date of formation of the company? ____/ _____/ _____ (DD/MM/YYYY)/ yet to be formed

B) Information about Promoters:

Qualification Work Experience

Name & Role Total
Degree/ Institute/ Domain
Companies Worked for Exp. (in
Diploma University Area(s)
yrs)
C) Brief Description of your Business/ Project:

Product/Service
Description

Pain Point addressed

Innovation introduced

Target customers

USP of product/service

Positioning amidst
competition

Any other highlights

D) Investments so far :

Name/ Source of Fund Amount Date

E) Incubation Requirement :

Preferred Location: Ghaziabad/ Lucknow

No. of Workstations: __________

I certify that the information contained in this application is accurate and complete to the best of my
knowledge. I understand that furnishing inaccurate or misleading information can result in denial of
consideration for admission or dismissal from IT UPVAN (IT Incubator).

Place : _____________ Signature: ________________

Date :______________ Name:_____________________

For any assistance or queries, please contact:

Ritu Dubey
Shreetron IT UPVAN Society
head.itupvan@gmail.com
+91-9999341638