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APPLICATION FORM
1) GENERAL INFORMATION:
Company Title:
Trade Register No:
Address:
City:
Postal Code:
Telephone:
Fax:
Web Site:
E-mail:
Tax Office:
Tax No:
Date of
Establishment:
Number of
Partners:
Total Number of
Employees:
Current Capital:
@
2) AUTHORITIES:
Name
Duty
Telephone
1.
E-mail
@
2.
@
3) NATURE OF THE PARTNERSHIP (The largest 5 partners)
Name-Title of the Partner
1.
2.
3.
4.
Position in the Company (If Applicable)
Share (%)
2/8
5.
APPLICATION FORM
4) LINE OF BUSINESS (Please mark X)
 Informatics Technologies – Information –
Software
 Electrical- Electronics – Electro mechanics
 Telecommunications
 Defence Industry
 Design
 Advanced Materials Technologies
 Medical Technologies
 Medical - Biomedical
 Environment
 Sustainable Energy
 Advanced Agriculture and Food
Technologies
 Construction
 Chemistry
 Nanotechnology
Other (Please Specify):
5) FINANCIAL INFORMATION (Last 3 Years):
Year
Sales (TL)
2010
2011
2012
Export (USD)
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6) PERSONNEL INFORMATION (in Numbers)
Qualifications of
the Personnel
PHD
Graduate
Degree
Undergraduate
Degree
R&D
Production
Management,
Sales, Quality, etc.
Other (Support)
3/8
Associate
Degree
Other
Total
APPLICATION FORM
7) R&D INFORMATION:
Primary Products and
Services
R&D Personnel Information
Name-Last Name
Education (University /
Department)
Position in the Company
Financial Data Regarding R&D
Years
R&D
Income
R&D
Expenses
R&D Export (If
any)
Any Grants, Funds, Credits Used for R&D
Projects
Amount (TL)
2010
Providing Institution
4/8
2011
2012
APPLICATION FORM
R&D Projects
(Completed or On-Going)
Name of the
Project
Brief
Description /
Objective
Budget
Customers (if
any)
Current Status
R&D Partners / Collaborating Institutions
Institution
Project
Type/Form of Collaboration
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Received or pending patent (if any)
and/or patent application
(Subject and number)
APPLICATION FORM
8) INFORMATION ABOUT YOUR UNIT AT IZMIR BILIMPARK
How do you want to take part in
Izmir Bilimpark?
 Moving the entire company
 Opening a central office
 Opening a branch office
 Establishing a new company
 Other (starting an incubating centre, etc.)
Any previous techno park
applications and results (if any)
Information Regarding the Space Demanded
Size of the space demanded (m2)
Deadline for the space demanded
The length of time you plan to stay at Izmir
Bilimpark
The number of personnel to take part at Izmir
Bilimpark
Total number of R&D personnel to take part at
Izmir Bilimpark
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Any special machinery/equipment/ devices
you plan to use at your Izmir Bilimpark Office
(if any)
Any special needs for your office (if any)
APPLICATION FORM
Personnel Information to take part at Izmir Bilimpark
Name-Last Name
Education (University /
Department)
Position in the Company
Information Regarding the Projects You Will Run at Izmir Bilimpark
(Please fill out a separate form for each project)
Project Title
Starting Date
Estimated Ending Date
Budget
Estimated Man Power
Customers (If Any)
Brief Purpose/Scope
Supporting Institutions, Organizations
Project Goals
Develop New Products/ Services
7/8
Improve the Products and/or
Production Methods
Lower the Cost of Production and
Expenses
Increase the Quality or Standard of the
Products
Prevent the Need for Import
APPLICATION FORM
Your Collaboration with Izmir University of Economics
Department
Project (Current project or
project you wish to improve)
Type of Collaboration (employing
academicians, academic advising, use
of laboratories, etc.)
Your Expectations/Benefits from Izmir Bilimpark
(Please specify the level of importance)
Very
Significant
Significant
Not
Sure
Insignificant
Very
Insignificant
Benefitting from tax deductions and other
legal incentives
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Making a collaboration with the
University
Benefitting from the academicians
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Benefitting from a qualified work force of
students and graduates
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Establishing synergy and partnership
mechanisms with other companies at
Izmir Bilimpark
Improving the company prestige and
image by taking part at Izmir Bilimpark
Offering better working and living
standards to employees by taking part at
Izmir Bilimpark
Benefitting from the infrastructure and
administrative services within Izmir
Bilimpark (internet, food, cleaning,
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security, transportation, etc.)
Benefitting from the high quality support
services within Izmir Bilimpark (trainings,
seminars, consultancy, incubation centre,
etc.)
Benefitting from the social and cultural
resources within Izmir Bilimpark
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APPENDICES:
 A separate Project Information Form will be filled out for each planned project
 Please attach the Trade Registry Gazette involving the purpose-subject of the company