BANNARI AMMAN INSTITUTE OF TECHNOLOGY-

TECHNOLOGY BUSINESS INCUBATOR

(BIT-TBI)
BANNARI AMMAN INSTITUTE OF TECHNOLOGY
SATHYAMANGALAM - 638 401

APPLICATION FORM FOR INCUBATEES

Name of the Organization :

Name of the Entrepreneur :
Age & Date of Birth :
Address for Communication :

Permanent Address :

Phone Res :
Off :
Mobile :
Email :

Educational qualification :

Name of the University / Year of

Class/Course Branch % Secured
College/Institution Board of study pass

Innovative Skills & Experience:

1
Type of Business:

Brief description of Product and Business/Service:

(Attach separate sheet)

Start-up Year:

A one page write-up on why you want to become an entrepreneur:

Legal position :

Proprietorship / Partnership / Corporation / Private

Service expected from BIT-TBI :

Facilities Yes No
Workspace
Shared office services
Access to specialized equipment
Management assistance
Business planning
Access to finance
Technical assistance
(Testing & Quality control etc.)
Networking support
Branding and marketing
Patenting
Mentoring/ Counselling
Technology Upgradation (R & D)/Value
Addition

Details of your Team:

Number of employees that will be resident (if applicable):

Full-time________

Part-time__________
2
Consultants_________

Number of employees in the Organization :

Promoter details :

Name of the Promoter :

Educational Qualification :
Designation :
Years of Experience :
Address for Communication :

Permanent Address :

Phone Res :
Off :
Mobile :
Email :

Fax :

Estimated Project cost with breakup details:

(in table format)

References:

1 Name of the Reference :

Designation :
Address :

Phone :
Email :

3
2 Name of the Reference :
Designation :
Address :

Phone :
Email :

Date: Signature

Place:

4
 FOR OFFICE USE ONLY
Name of the Firm/Organization
Room No
Area
Intercom No
Advanced paid with details

Date
Facilities provided by BIT-TBI
Facilities Details Charges
Cubicle
Fan
Tubelight
Executive Chair
Visitor’s Chair
Computer with Table
Internet Connectivity
Telephone Line
Fax
Photocopies
Laboratory Equipments
R&D
Others

Remarks:

Date: PRINCIPAL SCIENTIST & HEAD

BANNARI AMMAN INSTITUTE OF TECHNOLOGY

SATHYAMANGALAM - 638 401

BIT-TBI

Submitted to the Director for approval: 7th February 2009

Through:

5
Proper Channel

Sir,

Sub: Approval of Incubatee application format.

We are enclosing herewith the format of the incubatee’s application, for

Director’s kind perusal and approval. We also request the Director’s suggestion/s if any,
for the modification of the format.

Kind regards.

Yours Sincerely,

Dr. K. Subramanian
Professor & CEO I/c
BIT-TBI

Encl: Proposed application format for the incubatee.