Status of the Application

1. Name / Proposed Name of the Start-up *

2. Mobile *

3. Email * Invalid Email Id

4. Website (i.e: https://www.goole.com)

5. Name & Address of the Lead Entrepreneur*
(Brief Bio Data and Detailed Proposal to be attached)

6. PAN Details * (Upload PAN card scanned copy using below upload field ) Please enter valid PAN Number

7. Aadhar Number *(Upload Aadhar card scanned copy using below upload field )

8. Is your company a registered entity? If yes, please provide the registration number.

9. Is your company registered with Start-up India portal/website? If yes, please provide the Number.

10. Details of partners, if any. (Also include Biodata of Each partner)

11. Brief Description about your product / process / technology which is to be incubated at CIPET:SARP-ARSTPS

12. What is the current stage of your product / process / technology?

13. Have you applied for incubation / funding from other agency in India or Abroad, if yes, please provide the relevant details here?

14. Have you done market and consumer survey? Describe your target market, have your done the survey? Please attach the survey result/analysis.

15. What kind of incubation is expected from CIPET:SARP-ARSTPS?

16. How long you would like to be incubated by CIPET:SARP-ARSTPS?

17. Brief outline on the novelty / innovation of your product / process / technology.

18. List out your potential Customers. What marketing tools will you use to sell your products or service?

19. Scope of employment generation through your start-up.

20. Any other information to be provided

Notes

1. Details shall be filled in separate sheets as Annexure wherever applicable

2. Copy of all relevant documents / certificates to be attached.

21. Declaration

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to incubate me at CIPET: SARP-ARSTPS shall cancel my application / eviction from the centre in future, if incubated/pre-incubated. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my application, I agree to abide by the rules and regulations of the CIPET: SARP-ARSTPS, which rules may be changed, withdrawn, added or interpreted at any time, at the CIPET: SARP-ARSTPS sole option and without prior notice to me. I also acknowledge that my incubation may be terminated, or any offer or acceptance of incubation/pre-incubation withdrawn, at any time, with or without cause, and with or without prior notice at the option of the CIPET: SARP-ARSTPS or myself.

22. Signature of the Applicant * (Please upload white background signed photo.)

Type the number:

APPLICATION TO REGISTER AS INCUBATES

Notes

21. Declaration