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(CCMF) Cyberport Creative Micro Fund (CCMF)

1. Please fill in the application form in English.

2. Read the CCMF Brochure and CCMF Guides & Notes before filling in this Application Form.

3. Please submit 1 softcopy and 3 hardcopies of this form to the following addresses:
1 3 Cyberport Creative Micro Fund Cyberport Management Company Limited Entrepreneurship Centre Unit 518, Level 5, Cyberport 3 (Core F), 100 Cyberport Road , 100 , 3 F ,5 518

4. For enquiries on Cyberport Creative Micro Fund (CCMF), please call (852) 3166 3900 or email to
ecentre@cyberport.hk. (852) 3166 3900 ecentre@cyberport.hk.

APPLICATION FORM
1. APPLICATION STREAM
Please choose one of the streams below: : Professional Stream
Hong Kong Young Entrepreneur Programme

2. YOUR PROFILE AND ELIGIBILITY


Yes 2.1 Are you over 18 years old? 18 ? 2.2 Are you below 30 years old? 30 ? No

2.3 Are you currently enrolled under a registered post-secondary education institution in
Hong Kong? ?

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2.4 Do you have a Hong Kong Permanent Identity Card or presently have a company
registered as a legal entity and incorporated in Hong Kong or plan to establish one if awarded the CCMF grant? ? ? ?
Yes No

2.5 Is your idea rooted in ICT-related areas? ICT ? 2.6 Have you received more than HK$500,000 in funding from outside sources during the past 18 months? 18 $500,000 ? 2.7 Is this application a re-submission of a previously submitted project to CCMF?

3. PROJECT INFORMATION
3.1 Project
Name: : Overview : English (Within 300 words) ( 300 ) (Eng) () (Chi) ()

Chinese (Within 500 words) ( 500 )

3.3 Description :
(Detail description of your project. Vision, value proposition, direction, short and long term objectives, market need for product, target market and marketing strategy.) ()

3.4 Anticipated Commencement and Completion Date :


Commencement Date: (day-month-year) (--) Completion Date: : (day-month-year) (--)

4. APPLICATION INFORMATION
4.1 Management Team (Vetting Weighting 20%) (Prior track record, execution ability, individual qualifications) (/ / )

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4.2 Revenue Model (Vetting Weighting 20%) (/ ) (Revenue Model, income stream)

4.3 Business Model & Time to Market (Vetting Weighting 30%) (Offerings, strategies, organisational structures, trading practices, operational processes and policies, time to market launch) ( / / / / / )

4.4 Technology Innovation (Vetting Weighting 20%) (Use of innovative technologies, creative solutions, disruptive technology capability, emerging, or breakthrough technologies to solve a problem) ( / / / )

4.5 Social Responsibility (Vetting Weighting 10%) (Project focus on contribution to Open Source, Creative Commons and other progressive technologies with a social focus, exercise ethical decision making, or contribute toward solving a problem originating from the social environment) ( CC / / )

4.6 Competition Analysis (If applicable )

4.7 6-Month Project Milestone : (The Milestone proposed will form as a basis for continuous project review and evaluation if the Grant is awarded) ()

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Milestone 1-month 2-month 3-month 4-month 5-month 6-month

Details

4.8 Cost Projections (Cost of development and on-going operations) ()

4.9Exit Strategy (If applicable) ()

5. CONTACT DETAILS
Contact Person 1 (Principal Applicant) 1 () Last Name : (Dr. / Mr. / Ms. / Miss) ( / / / )

First Name : Position : Contact No: : Fax : Email Mailing Address: : (Home / Office / Mobile) ( / / )

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Contact Person 2 2 Last Name :

(Dr. / Mr. / Ms. / Miss) ( / / / )

First Name : Position : Contact No: : Fax : Email Mailing Address: : (Home / Office / Mobile) ( / / )

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6. DECLARATION
We hereby declare that: :

1.1 We have observed and agreed on the CCMF Guides and Notes to Applicants governing the
application of the Cyberport Creative Micro Fund Scheme;

1.2 All information provided in this application as well as the accompanying information reflects the
status of affairs as at the date of submission. I shall inform the Administration of the Cyberport Creative Micro Fund immediately if there are any subsequent changes to the above information;

1.3 The ideas of the proposed project are original without any constituted or potential act of
infringement of the intellectual property rights of other individuals and/or organisations;

1.4 We give our consent to Cyberport staff to carry out necessary due diligence/reference check for the
purpose of assessing this application. Name of Principal Applicant Organisation with Organisation Chop: : Signature of Principal Applicant: : Name of Principal Applicant: : On behalf of the Principal Applicant Organisation, the Principal Applicants Position Title : : Date (day-month-year): (--):

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