NEW YORK CITY OFFICE121 King Street, Melbourne Victoria 3000 Australia(888)123-4567info@example.comLONDON OFFICE121 King Street, Melbourne Victoria 3000 Australia(888)123-4567info@example.comBERLIN OFFICE121 King Street, Melbourne Victoria 3000 Australia(888)123-4567info@example.comWe Love To Hear From YouPlease call or email contact form and we will be happy to assist you. Applicant InformationApplicant Name (Incubatee)*Age* Educational Qualification and Experience if any* Postal Address* Postal Address* Fax* Email * Website (if any)* Current Professional* Company InformationHave you registered as a company* YesNoName of the company* Location from which company is operating* Company sector: Manufacturing/Services* Investment in plant and machinery (For manufacturing sector) / Investment in equipment (Forservices sector)* Company Type: Micro/Small/ Medium* MicroSmallMediumProject InformationTitle of the Technology/Innovation* Category of Technology/ Innovation (specify Process/ Product/ New Application/ other)* If it is an Innovative Idea, whether the idea is completely developed, if not how much time do you require to develop the idea* What are resources and support required to develop the idea * Do you have a patent of the idea? If no, when do you would like to patent it* Do you want to commercialise your innovation? If yes. What support from the Incubator are you expecting?* When do you plan to start commercial operations of your start up? Approximate Financial Year * 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 * Specify the potential areas of application in industry/market* Specify newness/ uniqueness of the innovation (better performance/ new features/ improvements)* What is already available in market? What is the market potential? What value it would add in market * Financial requirementsDo you have a business plan for taking innovation from lab to market?* What level of funding is required for making innovation market ready? * Please give activity wise break-up (Activities include design/prototype development/lab/bench scale Production/Professional Services/hiring staff/ trials/test marketing/ miscellaneous) (use annexure if space is not sufficient)* Other Related InformationAre there any team members/partner and mentors/guides in your innovative project. If so give name and complete contact address with phone and e-mail) * Information on Patents filed/granted (if any) * Any awards or recognition related to the innovation* Please include any further information that you wish to communicate to us to help us in judging your application * Contact InfoAddress: 121 King Street, Melbourne Victoria 3000 AustraliaPhone: (888)123-4567Email: info@example.com
