Application form for incubation at BITS BIRAC BioNEST
Are you an Entrepreneur looking for an ecosystem that can help you to build your Product?
Please fill the details in the form below and we will connect with you shortly.
For any queries please contact us at mridula@goa.bits-pilani.ac.in
Name of Applicant *
Your answer
Start-up name / Name of proposed Startup
Your answer
Address(physical)
Your answer
Email address *
Your answer
Contact Number *
Your answer
Describe Your Business Idea, Novelty/ Uniqueness / Unmet Market/ Social Impact (In 600 Words) *
Suggestion: What is the problem you are trying to solve? How do your customers presently solve this problem? How is your solution better than that of the competitors?
Your answer
Brief Description of the technology you plan to incubate with us
Your answer
Team members, if any: please provide their details *
Your answer
Please select the incubation services that you may require *
Required
Reasons for seeking incubation at BITS BIRAC BioNEST, Goa.
Your answer
Has your startup received any financial support? If yes, please provide the details
Your answer
For what duration would your startup require incubation support?
Your answer
Your exit strategy, if defined
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Any other information which would help in evaluating your proposal
Details of patents/publications/awards and recognition anything
Your answer
Give names, designation, affiliation and address (contact number and email) of two references:
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I certify that the information provided above is correct. *
Please certify that your start up/entity
Required
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