Application Form – Agripreneurship Orientation Programme

General Information of Applicant

* Name of the Candidate:
* Date of Birth:
* Email Address:
* Candidate's Mobile No.:
* Address for Communication:
Permanent Address (if different from Address for Communication)
Highest Qualification:

Furnish the details of your core team members in the table below

S.No. Name Designation Qualification Relevant Experience (in yrs)
1
2
3
4
5
* What motivated you to start up? (maximum 100 chars)
Max 100 Chars

General Information of Startup

* Name of your startup venture:
Website address of your startup, if any.:
* State:
* City:
When was your startup registered?:
If registered then which of the following legal entity is your business registered as or will be registered as?:
Legal Entity Name of the Organization
Sole Proprietorship
Registered Partnership
Limited Liability Partnership (LLP)
Private Limited Company
One Person Company (OPC)
Others
Is your startup registered at Startup India Portal?
* Specify main sector your startup works in? Please tick the box below: Precision Farming
Agricultural Supply Chain
Post Harvest & Food Technology
Food Processing
IoT, ICT and AI in Agriculture
Natural Resource Management
Waste to Wealth, Secondary Agriculture
Agri Clinics & Farm Health services
Organic Farming
Agriculture Engineering
Animal Husbandry, Dairying
Agri-Input tools and technologies
Farm Mechanisation
Agriculture Biotechnology
Agri Ext Education

Business Model of Startup

* Problem Description (Problem you are looking to solve) (maximum 150 chars.):
Max 150 chars
* Describe your solution (About your product/service/innovation)? (maximum 150 chars):
Max 150 chars
* Profile of target customer (maximum 150 chars):
Max 150 chars
* How do you intend to acquire customers?:
Max 100 chars
* Who are your competitors? (maximum 100 chars):
Max 100 chars
* What is the Revenue Model of your startup (sources of income)?(maximum 100 chars)
Max 100 chars

Current Status of Startup and Progress made so far

* At what stage are you at developing your startup's product/offering? (please tick the box below): Idea/Concept
Completed prototype/Proof of concept/Minimum Viable Product
Product under trial/testing/Pilot
In market for less than an year
In market for more than an year

* What potential industry partners and/or customers have you met with to validate your idea? (maximum 100 chars):
Max 100 chars
* Please specify the amount and source of funding received till date (in case applicable) (maximum 100 chars):
Max 100 chars

Additional information

Describe business goals for the next one year? (maximum 100 chars):
Max 100 chars
Describe expected take-aways (non-financial) from the CCS NIAM incubation program? (maximum 100 chars):
Max 100 chars
How did you hear about the program? (maximum 100 chars):
Max 100 chars
Is your business model/idea/startup eligible for acquiring Intellectual Property Rights (IPR)?:
Max 100 chars
What is the social impact of your business model/idea/startup (How it will benefit to farming Community)? (maximum 100 chars):
Max 100 chars
Any additional information that you think would be helpful to consider your application. (maximum 100 chars):
Max 100 chars

Disclaimer
Every effort will be taken to treat and handle this information as confidential however by signing and applying to CCS NIAM-COE for incubation, you agree not to make any claim or demand compensation in any form, at any point of time, on the information or technology details provided by you as trade secret or proprietary intellectual property. This information will be used by CCS NIAM-COE to assess your application for the purpose of providing incubation services. Furthermore CCS NIAM-COE does not guarantee acceptance of your proposal until and unless the selection process is over and CCS NIAM-COE has the right to reject any proposal at any point of time without assigning any reason to it. The decision of CCS NIAM-COE will be final and no explanation or justification for any aspect of the selection process shall be given.

* Place * Date
Signature of the applicant:
Documents Required:
* Photo
* Identity Proof of Applicant
Educational Certificate (Optional)
Company Incorporation Certificate (Optional)
Business Plan (Optional)