Application for KUBIC Participation

Complete and return this application to [Sujata Dhakal] at

Company Background

Company/Project Name: Primary Contact: Er. / Mr. / Ms. Other Member Name

Please provide a brief description of your business/idea:

Primary Contact Information

Address

Phone: Email:

Team (including yourself)

Member #1: Er./Mr./Ms. Position: Member #2: Er./Mr./Ms. Position:

Member #3: Er./Mr./Ms. Position:

Member #4: Er./Mr./Ms. Position:

Member #5: Er./Mr./Ms. Position:

Kathmandu University Business Incubation Center (KUBIC) – Kathmandu University, Dhulikhel, Kavre Page | 1 Product/Service

List each product/service that your company intends to market: List and Specify

Market Who are your potential customers, and what is the size of your market?

Who are your key competitors?

Intellectual Property Does your project/idea is patentable? Do you have intention for patent registration? List any other safety/health hazards:

Access to Lab / Equipment Needed (KUBIC provide approval of any lab / equipment / processing facility within University, and also help connect to appropriate agency / institution within the network of KUBIC) List the types of equipment/machines that your company expects to use:

KUBIC Shared Office Space Use

Are you applying for virtual/ residential candidate? If residential, how many people will work at KUBIC space?

Kathmandu University Business Incubation Center (KUBIC) – Kathmandu University, Dhulikhel, Kavre Page | 2 What aspects of your Business/Project/ Idea require assistance from KUBIC? Office space

Computer (Not more than One for one group)

Printer/ Communication facilities

Internet facility

R&D facilities (access to Laboratory, Library and research center)

Business plan assistance

Administrative and secretarial service supports

Business registration support

Mentoring, Advising

Legal services support

Branding/Labeling/Designing

Entrepreneurship/ Skill development trainings

Observational industrial tours

Marketing support

Business networking support

Networking Investor/Financing Strategy

Recommendation

Financial Details: Please provide your estimation and intended support from KUBIC

Kathmandu University Business Incubation Center (KUBIC) – Kathmandu University, Dhulikhel, Kavre Page | 3 Certification My signature below certifies that all the information contained in this application is true and complete. I also understand that the information contained in this application will be used only to determine my eligibility to lease space in KUBIC and will be kept confidential.

Applicant Signature Title Date

Kathmandu University Business Incubation Center (KUBIC) – Kathmandu University, Dhulikhel, Kavre Page | 4