IIM Calcutta, Diamond Harbour Road, P.O. Joka, Kolkata - 700 104, India
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APPLICATION FORM INVENT
To apply for the incubation programme at IIM Calcutta Innovation Park, please fill the following information:
Name Of Social Enterprise:
Sector: (Mark YES in front of any ONE of the following; If ‘Others’, please specify): Agriculture, Food, Diary
Healthcare, Water and Sanitation
Technology and Development Education Housing Handicrafts Energy Microfinance/Financial Inclusion Others
Contact Details:
PRIMARY CONTACT PERSON (Should Be One Of The Full Time Founders)
Designation: Email:
Mobile Number:
Registered Address:
Office Address (if different from above)
Office Phone
Website (if any)
Legal Status of firm: (E.g. Sole Owner/ Pvt Ltd / Partnership) Registration number and date: Firm registration (as applicable)
IIM Calcutta, Diamond Harbour Road, P.O. Joka, Kolkata - 700 104, India Phone: +91 33 2467 8300/8306, 2467 8313 | Fax: +91 33 2467 7174/7851/8062 | www.iimcip.org Reg. No. U74900WB2014NPL203219 | PAN No. AADCI6526M | TAN No. CALI04182D APPLICATION FORM INVENT
What problem are you trying to solve?
Describe your offering (product or service) with key features, Explain how it addresses the need
What is the social impact that your venture can generate? (Please support with numbers)
IIM Calcutta, Diamond Harbour Road, P.O. Joka, Kolkata - 700 104, India Phone: +91 33 2467 8300/8306, 2467 8313 | Fax: +91 33 2467 7174/7851/8062 | www.iimcip.org Reg. No. U74900WB2014NPL203219 | PAN No. AADCI6526M | TAN No. CALI04182D APPLICATION FORM INVENT
Who is/are the END CUSTOMERS? and why they would use your product / service?
Technology behind the core offering by the Start-up (tick applicable): To be developed Self Developed Acquired / Licensed Off the Shelf
If Self Developed – technology development time & linkages used / is the technology Patentable / status of patent and-or application / countries where applicable / if not yet patented what are the strategies for protection
If Acquired / Licensed – from whom & terms – conditions
If Off the Shelf – comments on the ‘innovation’ from the startup
IIM Calcutta, Diamond Harbour Road, P.O. Joka, Kolkata - 700 104, India Phone: +91 33 2467 8300/8306, 2467 8313 | Fax: +91 33 2467 7174/7851/8062 | www.iimcip.org Reg. No. U74900WB2014NPL203219 | PAN No. AADCI6526M | TAN No. CALI04182D APPLICATION FORM INVENT
Current Status
What is the current status of the business - ideation/ under development/ pilot launch/ revenue generation started etc .
Do you have paying Customers?
List your major customers / first adopters (if any)
Details of all Founders
SL No Name Educational Qualifications Work Permanent Contact: (Std. passed / Degree, Year, Experience Address Phone, Mobile, University) (Company, No. Email of Years, Functional Area)
IIM Calcutta, Diamond Harbour Road, P.O. Joka, Kolkata - 700 104, India Phone: +91 33 2467 8300/8306, 2467 8313 | Fax: +91 33 2467 7174/7851/8062 | www.iimcip.org Reg. No. U74900WB2014NPL203219 | PAN No. AADCI6526M | TAN No. CALI04182D