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Applicant Email* Applicant Name* Contact Details (Address, Phone, Email, website etc.)* Date of Birth* Professional Qualification*
Startup/Individual* StartupIndividual
Company Registration Details (Registered Address, Date Of Incorporation, DIPP Registration Details)* Title Of The Technology Innovation* Time Required For Prototype Readiness* Details Of Proposed Idea / Innovation (Will Be Kept Confidential)* Category Of Technology / Innovation (Specify Process/Product/New Application/Other)* Specify The Potential Areas Of Applications In Industry / Market* Brief Description About Novelty (IPS, FTO, Similar Products / Services / Technology Availability)* Brief Description About Projected Business Model* Brief Description About Current Status Of R&D Efforts And Other Technological Inputs For The Development Of The Product* Market Info – Available / Potential* Current Development Status - Technology Readiness Level* Are There Any Team Members/Partner And Mentors. Please Attach Brief CV For Each Team Members* Patents If Any* Awards If Any* Please Specify Incubation Period For Which CMIE Facility (Space And Equipment) Required* Space Requested* Major Equipment Required* Is Your Company Incubated At Any Incubator At Present? If Yes, Then Kindly Specify The Name Of Incubator And The Current Status Of The Incubation* Does The Proposed Project Involve Use Of Clinical Samples, Human Samples (Urine, Blood Or Any Tissues), Animal Study, Clinical Trial And Microbial Pathogenic Strains? If Yes, Then Kindly Specify The Nature Of The Biological Sample* Please Specify, If Any Biosafety Clearance Or Ethical Clearance Required For The Proposed Project To Be Executed At CMIE* Number Of Your Employees Who Will Be Working On Your Proposed Project At Any Given Time In CMIE Premise* Fund Raised Till Now* Annual Turnover* Incubation Help You Expect From CMIE* Pitch Deck* Only PDF, JPEG, JPG files allowed. Total file size 50MB. Declaration* I here by certify that the information furnished in the application form is true, complete and best to my knowledge.
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