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Manage Ac&Abc Incubation Centre: Membership Application Form

The document is a membership application form for an incubation centre called MANAGE AC&ABC Incubation Centre. It requests personal information from applicants such as name, date of birth, nationality, education, work experience, and contact details. It also asks about the applicant's business or technology idea, details of the product or service, requirements from the incubation centre, sources of funding, and references. The purpose is to evaluate proposals for membership to the incubation centre from individuals with new technology concepts or start-up companies in relevant technology fields.

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22 views

Manage Ac&Abc Incubation Centre: Membership Application Form

The document is a membership application form for an incubation centre called MANAGE AC&ABC Incubation Centre. It requests personal information from applicants such as name, date of birth, nationality, education, work experience, and contact details. It also asks about the applicant's business or technology idea, details of the product or service, requirements from the incubation centre, sources of funding, and references. The purpose is to evaluate proposals for membership to the incubation centre from individuals with new technology concepts or start-up companies in relevant technology fields.

Uploaded by

Bookbuzz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MANAGE AC&ABC INCUBATION CENTRE

MEMBERSHIP APPLICATION FORM

Personal Information
Name of the Applicant:

Date of Birth:

Gender

Nationality:

Contact Address with Phone Number

Web-Site:

E-mail:

Education

Work Experience

Partners/Directors 1.

2.

3.

Please indicate your status:


You have a novel technological idea/ concept and hope to convert Yes No
it in to a commercially viable product/ services through
technological support/ R&D collaboration with MANAGE

You hope to become a new technology entrepreneur in 02 years Yes No

You own/ represent a Start-up Company engaged in a technology Yes No


business in which expertise/ research interest exists in MANAGE

1
BUSINESS/ IDEA DETAILS: Submit a separate sheet for this if required

1. Title of your Business/Technology proposal for membership

2. Brief Description of the Product/Services/Technology business you plan

3. Brief description of the requirements and other technological inputs you hope to resource from
MANAGE.

Please tick mark (√)

a) Infrastructure
b) Capacity Building
c) Technical Mentoring
d) Business Mentoring
e) Regulatory & Advisory Services
f) IP Facilitation
g) Networking
h) Funding

4. Have you interacted with the concerned faculty and has he/she/they consented to collaborate with
you?

5. Have you prepared a Business Plan? If yes, please submit a copy.

2
6. Please indicate your sources of funds

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. Please give names and address of up to 2 referees who are acquainted with your career profession/
achievement.

9. Any other detail, which would help in evaluating your proposal

Signature

Name of Applicant

Date

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