Your Registration No.

Applicant / Company Details:

Name of the Applicant / Company / Start up
(If you are not a registered/incorporated company and/or applying as an individual,insert complete name of the individual here)

Applicant Type
( If you are not a registered company and/or applying as an individual, select "Not Yet Registered")

RoC / Registration No.

Date of Incorporation

Pan Image / Related Document

DPIIT Registration No

DPIIT Certificate

Revenue Generated Amount (if any)

Website (if any)

Registered Address:

House No. / Area / Road *

City *

District *

State *

Pincode *

Country *

Present Address:

House No. / Area / Road *

City *

District *

State *

Pincode *

Country *

Name of the Applicant / Founder *

Contact No *

Email *

Gender *

Qualification *

Date of Birth *

Designation *

No. of Employees
(Excluding founders if any)

DIN

Number of Founder/ Co-founders

Reference
(How do you know about this program) *

Patent / Detail of intellectual properties(IPs), if any

What is the current team size *

Social Media Handles

Name of product / Idea / Solution

Detail of product / Idea / Solution

Domain (Please specify your area of work or domain) *

Technology
(Technology used in your idea/ product /solution) *

Innovative Feature/ Novelty / USP of Idea / Solution

Revenue Generation Steam / Methods

Target Customer *

Competitor (if any and key differences therefrom)

Stage of Implemetation *

Market Need / Market Segment

Already part of the Incubation Program / Scheme

Fund / Grant Received under the Program / Scheme (INR Lakhs)

Your motivation to participate *

Pitch file *