Atal Incubation Centre,NIPER || Boosting Innovation towards Transformation of Ideas to Products || ‘विचाराणां उत्पादेषु परिवर्तनं प्रति नवीनतां वर्धयितुंर्वन्’

Incubation Form! field * Are mandatory

Name of the Incubatee ^*

Date of Birth^*

Email Id^*

Phone Number ^*

Gender ^*

Address^*

Upload Address Proof (Attach valid ID Proof)^*

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PAN

Aadhaar Card/Driving License

Qualification

Area Of Intrest

Employment status

Startup Company Name (please write N/A, if not registered)

Company Type (if registered)

Company PAN (if registered):

Brief profile of team members / co-founders: Furnish details for each member.

Team Member (Please Select N/A, if no team member / co-founder available

Type of Incubation support required

Proposed project description to be carried out at AIC NIPER-Guwahati Foundation (In 200 Words.)

Background details / preliminary data of the project proposed (In 200 Words.)

Problem(s) that you are addressing (In 200 Words.)

Advantage over the current similar technology available in the market (In 200 Words.)

Does the proposed project involve use of clinical samples, human samples (urine, blood or any tissues) or microbial pathogenic strains? If Yes, then kindly specify the nature of the biological sample (In 200 Words.)

Please specify, if any biosafety clearance and ethical clearance required for the proposed project to be executed at AIC NIPER-Guwahati (In 200 Words.)

APPLICATION FORM FOR INCUBATION SPACE AND FACILITY

Incubation Form! field * Are mandatory

Brief profile of team members / co-founders: Furnish details for each member.

Team Member (Please Select N/A, if no team member / co-founder available