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About Us
Team
Industry Experts
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Incubation Benefits
Infrastructure
Pharmacy
Information Technology
Arts, Science & Commerce
Management
Business School
Polytechnic
Law
Architecture
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Application Form
Contact Us
Incubatee Application Form 2024
A. PERSONAL INFORMATION
1. Name of the Applicant
2. Date Of Birth
3. Gender
Male
Female
Prefer Not to Say
Other
4. Nationality
Indian
Other
5.Contact Address with Phone Number
6. Web-Site
7. E-mail
8. Education
9. Any Additional Professional Qualification or Certificates
10. Name of College
11. Verification Proof
12. Work Experience
13. Company Name & Type (Private/ Public/ LLP/ Sole Ownership)
14. Partners/Directors
B. STARTUP STATUS
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
Yes
No
2. You hope to become a new Pharmaceutical/ Science/ Technology/ Engineering/ Arts/ Law/ Management/ other entrepreneur in 02 years
Yes
No
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
Yes
No
C. START-UP IDEA / BUSINESS DETAILS
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
Infrastructure
Capacity Building 󠆸 󠆸
Technical Mentoring 󠆸
Business Mentoring 󠆸
Regulatory & Advisory Services 󠆸
IP Facilitation 󠆸
Networking
Funding
Other
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
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