1. Name of Applicant
2. Date of Birth
3. Gender MaleFemalePrefer Not to SayOther
4. Nationality IndianOther
5. Contact Address with Phone Number
6. Website
7. Email
8. Education
9. Additional Professional Qualification/Certificates
10. Name of College
11. Verification Proof
12. Work Experience
13. Company Name & Type (Private/ Public/ LLP/ Sole Ownership)
14. Partners/Directors
1. You have a novel idea/ concept and hope to convert it in to a commercially viable product/ services through support/ R&D collaboration with HABIT Foundation.YesNo
2. You hope to become a new Pharmaceutical/ Science/ Technology/ Engineering/ Arts/ Law/ Management/ other entrepreneur in 02 years.YesNo
3. You own/ represent a Start-up Company engaged in a Pharmaceutical/ Science/ Technology/ Engineering/ Arts/ Law/ Management/ other business in which expertise/ research interest exists in HABIT Foundation.YesNo
1. Title of your Business proposal for association with HABIT
2. Brief Description of the Product/Services/Business you plan
3. Brief description of the requirements and other inputs you hope to resource from HABIT Foundation InfrastructureCapacity BuildingTechnical MentoringBusiness MentoringRegulatory & Advisory ServicesIP FacilitationNetworkingFundingOther
4. Have you interacted with the concerned faculty and has he/she/they consented to collaborate with you? (If Yes, give their names with contact details)
5. Have you prepared a Business Plan? If yes, please submit a copy.
6. Please indicate your sources of funds (if any)
7. Profile of your Company, if already registered. (Type of business, details as date of registration etc. membership of stock exchange if any, key personnel/associates, specific achievements etc.)
8. Mention about any Patent filled/ Grant received/ Prototype developed/ Proof of Concept.
9. Please give names and address of up to 2 referees who are acquainted with your career profession/ achievement. 10. Any other detail, which would help in evaluating your proposal
11. Date 12. Place
Submit your Requirement
