Centre for Technology Business Incubator
For Office use only
Date of Receipt: ----------------------------Reference No: ------------------------------
Technology Business Incubator, BITS PILANI
Seed Grant Support Under TDB/TIDE Scheme
Detailed Application Form
1. Company Information
Name of the Start up/Incubatee:
Office Address:
Website & email id:
Telephone:
Fax:
2. Company Management Information
Name and Designation of the Contact Person:
Telephone/ Mobile Number:
Email id:
Educational Qualification:
Number of employees in the company (Permanent and contract employees):
Permanent Address:
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3. Details of other team members with designation, qualification and contact details, and Address:
i) __________
ii) _________
4. Legal entity:
•
Limited Liability Partnership__________
•
Private Ltd Company______
5. Company Registration No. (if registered already):
If company not registered, indicate months within which would be registered:
6. Business Plan of the enterprise:
Company profile and history:
Brief description of business of enterprise:
Brief description of proposed product/ innovative technology developed, highlighting its novelty and need:
7. Present Status and Progress of the company from the date of incorporation (indicate date of
incorporation):
Particulars
Year 1
Year 2
Year 3
Capital investment
No. of Employees
Annual Sales
8. Details of the status of the proposed product/technology developed (Add separate sheets, if necessary):
Prior work done on the product development
Development of the other related activities done so far (mention details of the
tie up agencies, co-investors, expert consultants, sub contractors and
outsourcing agencies, if any)
Identification of markets and projected percentage of market share
Details of Product or services market test
2
Testing and certification of the products by authorized bodies, if applicable.
Give details
Potential applications/user profiles and customer feedbacks
Details of the Pilot Implementation, if any
Details of the funding granted for prototype development with scheme and
granted amount from any other agencies, if any
Any other information relevant to the proposal
9. SWOT Analysis with respect to competitors:Your Company Competitor 1
Competitor 2
Competitor 3
Competitor 4
(mention name of
the competitor)
(mention name of
the competitor)
(mention name of
the competitor)
(mention name of
the competitor)
Strengths
Weakness
Opportunities
Threats
Strategies to get
over the
weakness
10. Define Business model of your venture:
3
11. Financial Projections (Give Profit and Loss Account, Balance Sheet and Cash Flow for Three Years)
:-
12. Project Description:Explain the Phases, Action plans, duration and Total Project Cost
Phases (Indicate time frame)
Action Plans
Estimated Project Cost
Phase 1
Phase 2
Phase 3
Total Project Cost
13. The amount needed as Seed fund Assistance:Purpose (Indicate specific uses)
Total
Amount
Required
Amount
proposed
for Seed
fund**
Amount to
be invested
by
promoters
Amount
to be
invested
from
other
sources
Justify
the
Usage of
Fund
amount
Product development
Testing and Trials
Test Marketing
Mentoring
Procurement of equipments
Professional Consultancy to engage
Professors/experts to work with small firms
Out sourcing of technical supports and
services for the company’s product
Filing of Indian / International patents and
concerned matter with a maximum support of
Rs. one lakh for each project / start-up
Manpower for day to day operations
Any other area as deemed necessary*
Total amount
*Would be considered if recommended by the Management/Executive Committee of TDB/TIDE.
**The amount of loan would be up to a maximum of 80% of the project cost of the incubating company.
14. Indicate major milestones in terms of completion of the project and revenue generation and breakeven point.
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15. Any other information on the Project:
Declaration:
I/We hereby declare that all the information give in this application are true, complete and correct to the best of
my /our knowledge and belief. In the event of any information found false or incorrect, my/our application will
stand cancelled.
Place:
Date:
Signature of the applicant
Name
Designation
Company Seal.
5
Birla Institute of Technology & Science, Pilani
Pilani Campus, Vidya Vihar
Pilani 333031, Rajasthan, India
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Tel:
Fax:
Web:
+91 1596 245073
+91 1596 244183
www.bits-pilani.ac.in/pilani