<p> www.venturecenter.co.in [email protected] Phone: 020-64011026 100, NCL Innovation Park, Dr. Homi Bhabha Road, Pune-411008, India. (Entrepreneurship Development Center)</p><p>Technology Refinement and Marketing Plan (TREMAP) Program http://www.venturecenter.co.in/tremap/ The TREMAP program helps individual technology innovators to commercialize their technology via industry partners/ entrepreneurs by helping them demonstrate a business case, develop a refinement and marketing plan for the technology and help identify potential licensors.</p><p>Ref. no. – Date - Application Form</p><p>1. Applicant information</p><p>1.1 Applicant full name</p><p>1.2 Nature of entity Individual/ Micro or Small or Medium scale Enterprises</p><p>Other (Please specify):</p><p>1.3 Affiliation/ profession</p><p>1.4 Full postal address for correspondence</p><p>1.5 Phone</p><p>1.6 Fax</p><p>1.7 Email</p><p>1.8 Nationality www.venturecenter.co.in [email protected] Phone: 020-64011026 100, NCL Innovation Park, Dr. Homi Bhabha Road, Pune-411008, India. (Entrepreneurship Development Center)</p><p>2. Brief non-confidential description of the technology/ invention</p><p>Title of Technology/ Invention</p><p>PROBLEM/ NEED: What is the problem solved or outstanding need meet by the invention?</p><p>SOLUTION: What is the solution provided by your invention?</p><p>DISTINCTION: How is your solution different from other available solutions to the same problem? Compare with competing products/ services? What is the key added advantage?</p><p>Current status of technology Select Status An idea An idea with detailed conceptual plan, drawings, designs etc Proof of concept/ principle completed Patents filed At least one prototype demonstrating value to target customer developed Preliminary discussions with potential licensors/ investors carried out Has your technology/ invention been recognized or honoured or given any awards by independent agencies/ organizations? www.venturecenter.co.in [email protected] Phone: 020-64011026 100, NCL Innovation Park, Dr. Homi Bhabha Road, Pune-411008, India. (Entrepreneurship Development Center)</p><p>3. First level self- assessment for fit info TREMAP scheme</p><p>3.1 Clear/ undisputed rights of technology/ invention is owned by Yes/ No individual innovator 3.2 Inventor/technology developer is seeking to license/ assign Yes/ No technology/IP rights to a unrelated party 3.3 Inventor/technology developer needs help in marketing and Yes/ No licensing technology 3.4 Technology has reached prototype stage and needs only some Yes/ No refinement/ testing etc 3.5 The technology has at least one novel component/ appears Yes/ No innovative 3.6 The technology appears patentable Yes/ No  Technology is not in the exclusion list  Technology has novel elements  Invention is non-obvious with respect to known technologies/ inventions/ literature  Invention has clear uses/ applications 3.7 The technology is scalable Yes/ No  The scale of technology implementation can be increased as per need. A clear path can be projected for scaling up technology (with potentially some scale-up risk)  The technology could potentially serve a reasonably large market 3.8 The technology is not in the exclusion list of TREMAP: Yes/ No  Commercialization of “pure” software (Embedded ICT systems with software can, however, be supported).  Defense technologies like arms & armaments  Herbal & pharmaceuticals products requiring long duration/ extensive testing, trials etc. www.venturecenter.co.in [email protected] Phone: 020-64011026 100, NCL Innovation Park, Dr. Homi Bhabha Road, Pune-411008, India. (Entrepreneurship Development Center)</p><p>4. Patent details (Applicable if patent has already been filed)</p><p>4.1 Patent applications: Provide Attach as Appendix 1 list here with  Title  Inventors  Country/region  Application number  Filing date  Current status 4.2 Attach first page of Attach as Appendix 2 published patent 4.3 Nature of invention Select Type of invention/ potential claims Composition of matter Material with certain features Product/device Method of use Process or method Algorithm per se Any others</p><p>5. Declaration:</p><p>I have studied the scheme information provided at http://www.venturecenter.co.in/tremap/ and understood the TREMAP process flow and scope of scheme benefits.</p><p>I understand that at this stage I am applying for the TREMAP program with no commitments or obligations from both parties.</p><p>I declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief.</p><p>Place: Signature of the applicant</p><p>Date: </p>