Innovations for Digital Health Care Innovation Application Form Company details1. Name of the Company *2. Email Address *3. Mobile Number *4. Is your company registered under the MCA? *NoYesCIN Number *5. Year of incorporation *6. Location *7. Memorandum of Association *Drag and Drop (or) Choose Files8. Articles of Association *Drag and Drop (or) Choose Files9. Incorporation Certificate *Drag and Drop (or) Choose Files10. GST Certification *11. Shareholding Details *0 / 25012. Audited Balance Sheet *Drag and Drop (or) Choose Files13. Valuation of company certified by CA *Drag and Drop (or) Choose Files14. Upload The following information in your company Letter Head with CA Certified *Drag and Drop (or) Choose Files1. Your Name 2. Company Name 3. Financial Year 4. Quarter 5. Total Turnover (In INR) 6. Gross Profit (In INR) 7. Other Overheads (All expenses except COGS, Depreciation & Interest) (In INR) 8. Interest on Loan (In INR) 9. Profit After Tax (In INR) 10. Cash Burn (In INR) 11. Cash Runway (Number of Months) 12. Number of Customers / Orders (reporting quarter) 13. Pipeline - Orders / Customers 14. Pipeline - Value (In INR) Mention NA If not ApplicableInnovation Details15. Problem-solution fit and who is your beneficiary segment?0 / 25016. Provide specifications of the proposed product/ technology/ solution (tool, device, algorithm, etc.) / process.0 / 25017. comparison with other technologies/gold standards in the industry? Provide details on the same, including both technical as well as commercial aspects.0 / 25018. Describe why your solution is poised to be the market leader in its category, and how your organization is planning to scale it up accordingly.0 / 25019. What stage is your solution at? *Pre-clinicalClinical validationLaunched in marketGrowth stage/ Revenue generating20. What is the Technology Readiness Level (TRL) of the innovation? *21. Pilot design, implementation plan, and risk assessment0 / 25022. Environmental and community impact of the solution0 / 25023. Potential for job creation in UK area0 / 25024. Potential to scale solution through UK channels (i.e partnerships, customers, LA market generally)25. Overall fit of startup and team within the UK startup community0 / 25026. Funding Stage:27. Provide details of your existing funding commitments/ funds received towards the proposed project (including grants and equity). If you have not received any funding, mention N/A.28. Have you filed for any patents?NoYes29. what is the patent filed for? *30. Describe the regulatory roadmap for your innovation in India and other countries. Provide the currently available certifications and approvals for the said innovation.0 / 250RegisterSave as Draft
