Vishwaniketan incubation center

Personal Information:

Name of Applicant: *

Father’s Name: *

Mother’s Name:*

Education: *

Email Id: *

Address:*

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Date of Birth:*

Sex:*

Nationality: *

Pan No.:

Aadhar Card No.:

Voter Card No.:

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Paassport No.:

Website, if any:

Member of Professional / Technical Association: *

Any other Initiatives, professional activities related to idea:

Experience – could be part-time work, seasonal activity etc:

Marketing:

Industrial:

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R &D:

Proposed Business information:

Technology Business Preference: *

What Is the Basic Idea?

Your strengths *

Challenges / Competitors*

Opportunity / Scope for growth from existing volume Seek professional help from finance advisor for approx. returns & investment *

Threats / Risks *

Which One Best Describes Your entity*

Startup Existing Yet to Startup

(Please specify target date of incorporation)*

Enter Company Details (If Applicable)

Official Name of Company:

Company Address:*

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Date of Incorporation:

SEC Registration No.:

PAN No.:*

TIN No.:*

Company Partners / Team Members:

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Contact Number:

Contact Time:

Technologies Used for development:

Target Market (Potential Size):

Identical business you know / studied?

Support expected from VIC:

Estimated Office Space Required:

Number of Employees:

Please Check All Office Support Services You Need:

Infrastructure Rapid Prototype Consultancy Idea assessment and vetting Electronic Product Designing Consultancy Mentors Assistance Legal Protection Financing Options Product Development Support
If others, please specify:

Dear Sir ,

I hereby declare that all the statements made by me in the application form and information sheet are true and complete to the best of my knowledge, belief and nothing has been concealed or suppressed. I understand that in case, any of my statements is found untrue during any stage of selection and thereafter, I shall be disqualified from the VIC and I shall be liable for any penal action. If any VIC lab / property / brand is damaged / misused by me / my company, I will be solely liable to bear the cost and refund the equivalent charges in lieu of the same; which could be either the resource / property replacement or the payment of amount.

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