PRAYAS - Individual Innovator Application Form


Latest Photo (not earlier than 6 months) *
1. Title of the proposed object *
2. Applicant and Team Details :
Name of the Applicant : *
Father's / Husband's Name :
Date of birth : *
Gender*
E-mail*

Category*
Phone Number:
Educational Qualification *

Postal Address*

Permanent Address*

Residence Proof*
Please enclose residence certificate issued by Sub-Divisional Magistrate(SDM)/District Magistrate(DM) or a coby of ration card or any other document regarding proof of residence
Profession of the Applicant
Name of the Institution/Organisation

Address of the Institution/Organisation*
No objection Certificate
Required for Students and working Innovator from Head of Institute / Organization
Latest income Tax Returns filed
Annual Income of the Applicant
Aadhar Card No.*
PAN Card No.*

Team Member Details *
(NOTE : If no team members,kindly mention NA in column Name)

Team Member - 1

Name
Aadhar No.
PAN Card No.
Gender
Contact details
E-mail Id
Qualification

Team Member - 2

Name
Aadhar No.
PAN Card No.
Gender
Contact details
E-mail Id
Qualification

Team Member - 3

Name
Aadhar No.
PAN Card No.
Gender
Contact details
E-mail Id
Qualification
3. What is the problem you are trying to solve ? *
4. What are the existing solutions in the market? *
5. What is your solution/technology/product and what is the science and working principle behind your idea? *
6.Who would be prospective buyers of your product and what is the size of the addressable market? *
7. Have you done any validation to check the need for/feasibility of your idea? If yes, then please describe who all you spoke with and what was their feedback? *
8. Who are the competitors in your market? What is your unique value proposition vis-a vis- the competitor? *
9. Do you have any Patent/Copyright for your innovation?
If yes, please provide the details. *
10. Please indicate the current stage of your innovation *
Idea Level
College project
Lab level proof of concept
Paper presentation
Working Prototype ready
Market ready product
11. What is the final outcome/deliverable of the project? *
12. Upload Image of Product(if any)
Video Link of Product(if any)
13. Proposed costs and time frame *
Project Cost's- Own Share Contributed PRAYAS support sought
Outsourcing Charges for R&D / Desig / Engg / Consultancy / Testing / Expert cost
Raw material/ Consumables / Spares
Fabrication / Synthesis charges of working model or process
Business Travel and Event participation Fees (Ceiling 10% of approved project cost)
Parent filing Cost - (PCT - Ceiling 10% of approved project cost)
Contingency - (Ceilling 10% of approved project cost)
Total

Project period in months: (Not more than 18 months) *
14. Activity Details/Work Plan *
Activities Measurable Milestones Duration (Months)
1
2
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5
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9
10
15. Have you received any grant / financial support / award for your present work from any other resources? (If so, please furnish details) *
16. Essential Criteria *
Yes No
Applicant confirms that he/she or his/her team member 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.
Applicant is planning to pursue NIDHI - PRAYAS full time with no other concurrent commitments
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
Applicant has or is planning to register for the pre incubation or incubation program for the entire duration of PRAYAS support at the Maker Village as per its incubaton policy /terms.
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 Center (PC). 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
Applicant confirms that they will not avail the funding support in parallel for both the schemes i.e NIDHI - PRAYAS and NIDHI - EIR fromthe same or different centres.
17. Declaration
I declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. If any information is found false or incorrect, my candidature will stand cancelled and all my claims will be forfeited. I have not received any financial assistant for the present proposal from any other agency.
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Signature
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