"APPLICATION FORM FOR GENESIS"
1.Entity Details :-
Name of Entity:*
Type Of Entity:
--Select--
PVT. LTD.
LLP
Others
Not Registered
Date of Incorporation/Registration:
Registered Address:
Name of City:*
State:*
DPIIT Recognition no:
Women Led Startups:
--Select--
Yes
No
PAN No.:*
Upload your Company PAN Card:
Upload your Address Proof -*:
Where did you hear about us:*
--Select--
Facebook
Instagram
Twitter
LinkedIn
Wadhwani Foundation
Friends/ Colleagues
Any other
Select Category *:
SC
ST
OBC
GENERAL
To which sector does your Idea / Startup relate? (Multiple selections allowed) *
Agriculture
Blockchain
FinTech
Media
IT/Eclectronics
AR/VR/MR/XR
Social Impacts
Consumer
FMCG
Robotics
Tools Education
AI/ML
IOT
Other
Hardware
SAAS
Logistic
B2B
Drones
Healthcare
Software
2. Startup Details:-
Are you currently incubated/associated with any incubation center (YES or NO ):*
--Select--
No
Yes
If yes then mention Amount and Source of Funding (In one single Question)
Have you raised funds from any source for this idea/entity? (YES OR NO) :*
--Select--
No
Yes
If yes then mention Amount and Source of Funding (In one single Question)
what is the problem you are solving?:*
What is your unique selling point?:*
What will be the revenue model?:*
How do you aim to scale-up?:*
Proof of Identity:*
--Select--
Aadhar
PAN
Driving Licence
Stage of startup:
--Select--
Ideation & Conceptualization
Validation / Problem-solution fit
Proof of concept
Prototype / Working prototype
Website URL:
3.Startup Team:-
Name of the CEO:*
Mobile No.:*
Email ID:*
Linkdin Profile:*
Adhaar no.:*
Total no. of employees.:*
4. Upload Documents:-
Upload your pitch-deck-* (Pitch Deck must include :Problem Statement, Solution, Technology used, Market size, Sector, Business Plan, Team, EIR Fund utilization plan):
Upload video of Product/Service- :
Upload incorporation Certificates-:
Submit Now
