Name of the Fair / Event *

Name of the Participant *

Date of Birth

Name of the Startup company *

Address *

Phone

Mobile Number *

Email ID *

Website

Are you a first generation Entrepreneur? *

Whether Proprietary/Partnership/Pvt.Ltd/LLP *

Nature of Activity *

Name of the product Manufactured/Proposed to be Manufactured/Service *

Brief description of the product/technology(in 150 words)

Have you availed/availing any incubation support for product development *

If yes Name & address of the Incubation centre

Present status *

If existing date of commencement,total investment,source of funding & annual turnover

If proposed, are you looking for investment

If yes,mention required investment

Have you registered under Udyog Aadhaar? *

If yes,please furnish registration number

No.of employment generated

Whether patent filed? *

If patent filed present status