Vel Tech, India - Application Form for Inbound Students

Title of the proposed project *

Name of the applicant *

Father's name/Husband's name *

Date of Birth *

Email ID *

Mobile Number *

Landline Number

Gender *

Educational Qualification *

Category (General/SC/ST/OBC)*

Postal Address *

Permanent Address *

Recent Passport size Photograph * File Description : 50 KB & jpeg/png

Signature * File Description : 50 KB & jpeg/png

Address Proof *
(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)

Startup - Company incorporation / MSME Certificate (less than 7 years old company) * File Description : 200 KB & jpeg/png

Name of the Directors/Authorised persons of company *

Company PAN Card no *

Profession of the Applicant *

Applicant working - Name & Address of the Institution/Organization *

NOC Certificate
(For Innovator in Employment / Students with any R& D organisation / Academic Institution No Objection Certificate Upload NOC from Head of Institute /Organization is mandatorily required) * File Description : 200 KB & jpeg/png

Annual Income of the applicant
(attach a copy of the latest Income Tax Returns filed) File Description : 200 KB & jpeg/png

Aadhaar No *

Applicant PAN Card no *

Aadhar
(attach a copy of the latest aadhar card) File Description : 200 KB & jpeg/png

Pancard
(attach a copy of pancard) File Description : 200 KB & jpeg/png

Have you started your own venture (start up) ? *

Name of your start up *

Your Role in start up (eg.CEO,COO,Product Head)*

Date of Incorporation *

Revenue generated till date *

Provide Cap structure of the startup*

Name (Founder/Co-founder) *

Nationality *

Commitment (P-time/F-time) *

% share holding *

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TEAM MEMBERS DETAILS

Name *

Aadhar No. *

Pan Card no. *

Gender *

Contact *

Email-id *

Qualification *

Add More

Brief description of the idea highlighting innovative element. *

Please mention the hardware component which will be developed in the proposed prototype.*

Status of work already carried out (if any) such as. *
Please tick as applicable. Idea Level
College Project
Lab Level-Proof of Concept
Paper Presentations
Working Prototype Ready
Any other

Science and working principle behind the idea *

Final outcome/deliverable of the project *

Who would be the beneficiary of this innovation and why?*

Proposed costs and time frame *

SI.No	Items	Project Cost Own Share	PRAYAS support sought
1.	Outsourcing Charges for R&D/Design Engg/Consultancy/Testing/Expert cost
2.	Raw material/ Consumables/Spares
3.	Fabrication /Synthesis charges of working model or process
4.	Business Travel and Event participation Fees (Ceiling 10% of approved project cost)
5.	Patent filing Cost - (PCT- Ceiling 10% of approved project cost)
6.	Contingency - (Ceiling 10% of approved project cost)

Project period in months: (Not more than 12 - 14 months) *

Activity details/work plan *

Activities	Monitorable Milestones	Duration (months)

Have you received financial support / award for your present work from any other sources? * Yes No

Have you been Approved / Received the NIDHI-PRAYAS ? * Yes No

Essential Criteria *

Have you also applied / in process of applying to any other PRAYAS Centre (s) for NIDHI-PRAYAS and/or NIDHI-EIR grant * Yes No

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.	Yes No
Applicant is planning to pursue NIDHI- PRAYAS full time with no other concurrent commitments	Yes No
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	Yes No
Applicant has or is planning to register for the pre incubation or incubation program at the TBI for the entire duration of PRAYAS support	Yes No
Applicant confirms that if selected for NIDHI-PRAYAS, then they (applicant and their team members) will avail support for their project from only one PRAYAS Centre. If the applicant is found seeking NIDHI-PRAYAS support for the same idea from two different PCs, then the PC reserves right to discontinue the PRAYAS support and appropriate action will be taken on the applicant.	Yes No
Applicant confirms that they will not avail the funding support in parallel for both the schemes i.e NIDHI-PRAYAS and NIDHI - EIR from the same or different centers.	Yes No

NIDHI-PRAYAS Programme of Department of Science and Technology, Government of India National Science and Technology Entrepreneurship Board (NSTEDB) PRAYAS - Innovator Application Form

TEAM MEMBERS DETAILS

Proposed costs and time frame *

SI.No

Items

Project Cost Own Share

PRAYAS support sought

Activity details/work plan *

Activities

Monitorable Milestones

Duration (months)

Essential Criteria *

NIDHI-PRAYAS Programme of
Department of Science and Technology, Government of India
National Science and Technology Entrepreneurship Board (NSTEDB)

PRAYAS - Innovator Application Form