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Application Form for Incubation Program
Name of the Founder/Promoter
*
Gender
*
Male
Female
Other
Age
E-mail
*
Mobile Number
*
City
*
State
*
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Andhra Pradesh
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Education
College/Institution?
Address
*
Name of the Company/Startup/Idea
*
Social Media Account
Website
Is your Startup Registered?
*
Yes
No
Startup Registered Date
Team Size
*
Uddyam No.
DPIIT No.
Sector
Agri-Tech
Agri-Tech
Defence
Green Mobility
Health-Tech/ Med-Tech
Smart City Industrial Services
Design/ Architecture & 3D Printing
Electricity, New and Renewable Energy and Environmental sustainability
Energy/ Power
FMCG/ Food Processing
Hospitality/ Entertainment
HR and Ed-Tech
IoT/ Automation/ AI
ITeS/ Web/ SaaS/ IT
Waste/ eWaste Management
Manufacturing and Engineering
Fin-Tech
Others
Stage of Startup Idea
*
Ideation
Prototype
Pre Revenue
Already In Market
What Problem are you solving?
*
0
/ 100
What is your Solution?
*
0
/ 200
Do you have Patent?
*
Yes
No
If yes please provide the Patent number?
Target Customers
Do you have paying customers?
*
Yes
No
If Yes, What is the revenue generated till date?
.How did you find us?
*
Magic Events
Social Media
Mailers
News Paper
Whats App
Others
If Social Media, please select the platform
Facebook
Twitter
Linkedin
Instagram
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MSME
iDEX
Startup India Seed Fund
Portfolio
Ecosystem
CSR Partners
Ecosystem Partner
Startup Ecosystem
Industry
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