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Incubatee Application Form

FORM-1

Proposal No.
(To be filled by office)
Title of the proposal

1. Applicant Information (INDIVIDUAL)

1.1 Applicant’s Full Name
1.2 Affiliation/Profession
1.3 Full Postal Address for Correspondence
1.4 Phone
1.5 Fax
1.6 Email

2. Applicant Information (COMPANY)

2.1 Name of Company/ Organization (Registered or Proposed )
Name of Company/ Organization (Registered or Proposed )

2.2

Contact Person Details

a)

Phone

b)

E-mail

c)

Fax

d)

Please attach: Resume
One file only.
50 MB limit.
Allowed types: pdf.
2.3 Address & Website of Company
2.4 Nature of Business
2.5 Date of formation of Company (Attach: 1. Certificate of Incorporation 2. Certificate of Recognition)
One file only.
50 MB limit.
Allowed types: pdf.

3. Information to be attached

3.1 One page on technology/research proposal
One file only.
50 MB limit.
Allowed types: pdf.
3.2 Letter from organization/employer showing consent as INCUBATEE at BBB
One file only.
50 MB limit.
Allowed types: pdf.
3.3 List of team members involved with profiles
One file only.
50 MB limit.
Allowed types: pdf.
3.4 List of proposed products and services
One file only.
50 MB limit.
Allowed types: pdf.
3.5 List of current directors and top management officials of company along with contact information
One file only.
50 MB limit.
Allowed types: pdf.
3.6 Details of existing fund/past fund
One file only.
50 MB limit.
Allowed types: pdf.
3.7 Resume of contact person
One file only.
50 MB limit.
Allowed types: pdf.

4. Services Requested

4.1 Incubation period & type of incubation
Incubation period & type of incubation

4.2

Space requested

S.No.

Facilities

Required (Y/N)

Size

Quantity

1.

Bench Space+ Sitting Space
Bench Space+ Sitting Space
Size

2.

Independent Lab
Independent Lab
Size

3.

Office Cubicle
Office Cubicle
Size

4.

Workstation Bench
Workstation Bench
Size
4.3 Other facilities required
Other facilities required
4.4 Major equipment required

5. EHS Information (Responsibility with the applicant)

5.1 Does the proposal involve use of hazardous chemicals/biological materials
Does the proposal involve use of hazardous chemicals/biological materials
5.2 If yes, brief description and proposed safety plan
5.3 Kind and quantity of waste generated would be

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Last Updated: 02/12/2025