Incubation Application Form
(To be filled by Incubation customer for STPI Mohali Building)
1. Name of the company
Your answer
2. Name of the Applicant
Your answer
3. PAN No. of the company (In case of Proprietorship, PAN Card of Proprietor)
Your answer
4. Contact Details
4.1 Registered Address
Your answer
4.2 Contact Address
Your answer
4.3 Mobile No.
Your answer
4.4 Fax No.
Your answer
4.5 Telephone No.
Your answer
4.6 Email Address
Your answer
5. Project Details
5.1 Prime Differentiator of the company & prominent companies competing in similar field of business (Attach the doc/pdf file if any with the seal/signed printout of the application to be submitted with STPI-Mohali)
Your answer
5.2 Funding requirements and status of the funding with respective references
Amount of fund (INR)
Your answer
Source of fund
Your answer
Reference for fund
Your answer
5.3 Details of the Promoter (Attach the doc/pdf file if any with the seal/signed printout of the application to be submitted with STPI-Mohali)
Your answer
6. Requirement Details
6.a.i Incubation Requirement - Raw Space
Required
6.a.ii Incubation Requirement - Plug N Play
Required
6.a.iii Incubation Requirement - Area requested(sq. ft.)
Your answer
6.a.iv Incubation Requirement - No of seats requested
Your answer
6.a.v Incubation Requirement - Raw/ DG (KVA/Month)
Your answer
6.a.vi Incubation Requirement -UPS (KVA/Month)
Your answer
6.b Bandwidth Requirement
If yes, Please enter how much bandwidth Required?
Your answer
7. Incubation Company Details
7.1 Type of company
7.2 Location
(Operating from single or multi-location)
7.3 Product or service to be developed
(Operating from single or multi-location)
7.4 Employment Generation per annum
7.5 Is the company availing any scheme benefits that is approved by MeitY?
7.5.a If yes, Give Details (Attach the doc/pdf file if any with the seal/signed printout of the application to be submitted with STPI-Mohali)
Your answer
7.6 Projected Employment & Revenue year wise for next 3 years
7.6.a Year 1
Your answer
7.6.a.i Employment for year 1
Your answer
7.6.a.ii Revenue for year 1
Your answer
7.6.b Year 2
Your answer
7.6.b.i Employment for year 2
Your answer
7.6.b.ii Revenue for year 2
Your answer
7.6.c Year 3
Your answer
7.6.c.i Employment for year 3
Your answer
7.6.c.ii Revenue for year 3
Your answer
7.7 Name of the Persons who authorized to work in your behalf
(Add name and contact number of each)
Your answer
7.8 Proposed period of use
(year/month)
Your answer
7.9 Expected date of occupancy
(dd/mm/yyyy)
MM
/
DD
/
YYYY
7.10 Turnover of the company(in Rs. Lakhs)
Your answer
7.11 IPR genreation (Attach the doc/pdf file if any with the seal/signed printout of the application to be submitted with STPI-Mohali)
If yes, give details
Your answer
I hereby agree that i will use this facility only for the purpose mentioned above. In case of any damage or missing of related Equipment/Accessories, i am liable to refund the entire cost of the above items. Further i agree to abide all the rules and regulations of STPI regarding Incubation facility
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