PRAYAS - Individual Innovator Application form
Email address *
Title of the proposed project *
Name of the applicant *
Father’s name/Husband’s name *
Date of Birth *
MM
/
DD
/
YYYY
Mobile Number *
Landline Number *
Gender *
Educational Qualification *
Category *
Address:
(Please enclose residence certificate issued by Sub-Divisional Magistrate (SDM)/District Magistrate (DM) or a copy of ration card or any other document regarding proof of Residence)
Postal Address *
Permanent Address *
Proof of Residence
Profession of the Applicant *
Annual Income of the applicant *
PAN Card No. *
Aadhaar No. *
Your Institution/Organization Details
(For Students and working Innovator, No Objection Certificate from Head of Institute /Organization is required)
Name and Address of the Institution/Organization *
Attachment of NOC if Student/Working Innovator
Proposed Idea Details
Brief description of the idea highlighting innovative element (100 words) *
Status of work already carried out *
Required
Science and working principle behind the idea (100 words) *
Final outcome/deliverable of the project (50 words) *
Who would be the beneficiary of this innovation and why? (100 words) *
Proposed costs and Time frame - NIDHI PRAYAS Support Sought(upto 10 Lakhs)
The NIDHI-PRAYAS Support sought is upto 10 Lakhs. Please divide the cost in each ground.
Outsourcing Charges for R&D/DesignEngg/Consultancy/Testing/Expert cost *
Raw material/ Consumables/Spares cost *
Fabrication /Synthesis charges of working model or process cost *
Business Travel and Event participation Fees (Ceiling 10% of approved project cost) *
Patent filing Cost – (PCT- Ceiling 10% of approved project cost) *
Contingency - (Ceiling 10% of approved project cost) *
Proposed costs and Time frame - Own Share
Outsourcing Charges for R&D/DesignEngg/Consultancy/Testing/Expert cost *
Raw material/ Consumables/Spares cost *
Fabrication /Synthesis charges of working model or process *
Business Travel and Event participation Fees (Ceiling 10% of approved project cost) *
Patent filing Cost – (PCT- Ceiling 10% of approved project cost) *
Contingency - (Ceiling 10% of approved project cost) *
Project period in months *
Not more than 18 months
Activity details/work plan
The NIDHI-PRAYAS duration is 12 months. Divide your activities and milestones according the provided duration.
1. Monitorable MileStones: These are the targets you have decided to achieve in each duration.
2. Activities: These are the brief of the activities you are planning to achieve the target milestone.
Duration: 0 - 3 months
Monitorable Milestones *
Activities *
Duration: 4 - 6 months
Monitorable Milestones *
Activities *
Duration: 7 - 9 months
Monitorable Milestones *
Activities *
Duration: 10 - 12 months
Monitorable Milestones *
Activities *
Essential Criteria
Applicant Confirms that he/she has not been a recipient of any NIDHI-PRAYAS or similar support previously for the same innovative concept as proposed in this form. NIDHI-PRAYAS can be used only once *
Applicant is planning to pursue NIDHI- PRAYAS full time with no other concurrent commitments *
Applicant confirms that he/she is fully committed to work towards the prototype development for which the support is being sought and should not treat this as a stop gap arrangement to support any other pursuits *
Applicant has or is planning to register for the pre incubation or incubation program at the TBI for the entire duration of PRAYAS support *
Have you received financial support / award for your present work from any other sources? *
Attach your latest Resume *
Required
Signature of the applicant *
Required
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