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Applicant Name*:
Applicant Email*:
Contact No.*:
Contact Address*:
Professional Qualifications/Educational Background*:

Startup/Individual*: StartupIndividual

Startup/Individual Name*:
Startup/Individual Address*:
Website if any:
Date of Incorporation, if applicable:
Corporate Identification Number / DPIIT / DIPP Registration Number, if applicable:
Is the company currently incubated with any other incubator? If yes, please specify*:
Awards/Grants/Recognitions, if any:

Title of the Technology and Innovation*:
Category Of Technology / Innovation*:
Lead Clinical Category*:
Technical Description of the Product / Technology, including working principle, key components, technical specifications, development approach, and current technical limitations*:
Brief Description About Novelty, target problem and unmet need*:
Current Technology Readiness Level*:
Time Required for Prototype Readiness*:
Brief Description About Current Status Of R&D Efforts And Other Technological Inputs For The Development Of The Product*:
Major Technical Dependencies, Infrastructure Needs, Testing Needs, or Specialized Facilities Required*:
Current Validation Status of the Product / Technology, if any:
Publications, pilots, prototype demonstrations, customer trials, or field testing completed, if any:

Need/Problem*:
Market Access Geographies*:
Market Size*:

Patents If Any*:
Freedom to Operate*:
Does the proposed project involve use of clinical samples, human samples such as urine, blood, tissues, animal study, clinical trial, or microbial pathogenic strains?*
Please specify whether any biosafety clearance, ethical clearance, regulatory approval, or institutional permission is required for the proposed project to be executed at CMIE.*:
Current status of any required regulatory, ethical, biosafety, or compliance approval*:

Number of employees / team members who will be working on the proposed project*:
Core Team Details, including name, role, qualification, relevant experience, and responsibility in the startup*:
Advisors, mentors, clinical collaborators, industry partners, or institutional collaborators, if any:
Fund Raised Till Now*:
Source of Funding, if any:
Annual Turnover, if applicable:

Specify Incubation Period Required*:
Space Requested*:
Major Equipment Required*:
Incubation Help Expected from CMIE*:
Mandatory Attachment: Detailed Pitch Deck covering startup overview, problem statement, technology/product details along with clear pictures of the prototype/product, novelty, technical development status, TRL, technical data, validation data, market opportunity, business model, team details, risk factors, funding status, milestones, and specific support expected from CMIE*: Only PDF, JPEG, JPG files allowed. Total file size 50MB.
Declaration*
I hereby declare that the information provided in this application is true and accurate to the best of my knowledge.