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PRAYAS - Individual Innovator Application form
NIDHI – PRAYAS Programme of Department of Science and Technology, Government of India National Science and Technology Entrepreneurship Board (NSTEDB)
Email address *
Application Reference number
To be given by Prayas centre
Title of the proposed project *
Details of Applicant
Name of the applicant *
Passport photo of applicant *
Required
Father’s name/Husband’s name *
Date of Birth *
MM
/
DD
/
YYYY
Mobile Number *
Landline Number *
Gender *
Educational Qualification *
Category (General/SC/ST/OBC) *
Postal Address *
Permanent Address *
Profession of the Applicant *
Name & Address of the Institution/Organization *
(For Students and working Innovator, No Objection Certificate from Head of Institute /Organization is required)
Annual Income of the applicant *
(attach a copy of the latest Income Tax Returns filed)
Income Tax Returns *
Required
PAN Card no *
(attach a copy)
PAN Card *
Required
Adhaar no *
(attach a copy)
Adhaar Card *
Required
Brief description of the idea highlighting innovative element *
Status of work already carried out (if any) such as *
Required
Science and working principle behind the idea *
Final outcome/deliverable of the project *
Who would be the beneficiary of this innovation and why? *
Proposed cost and time frames
Outsourcing Charges for R&D/DesignEngg/Consultancy/Testing/Expert cost *
Raw material/ Consumables/Spares *
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)
Have you received financial support / award for your present work from any other sources? *
If yes, details?
Declarations
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 *
I declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. If any information is found false or incorrect, my candidature will stand cancelled and all my claims will be forfeited. I have not received anyfinancial assistance for the present proposal from any other agency. *
Signature *
Required
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