Name
*
First Name
Last Name
E-mail
*
Job Title
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Company Name
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Company Website
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Company Description
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Major Technologies, Products & Services
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How impactful is your company?
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1
2
3
4
5
Assess the track record of yourself and your partners
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1
2
3
4
5
Rate your degree of connection to research, a university or a university ecosystem
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1
2
3
4
5
Which area does your product positively impact?
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Climate Change
Education
Health
Security
Sustainable Growth
Please provide further detail on how your product is impactful
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Does your company address any of the 17 Sustainable Development Goals?
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Yes
No
If yes, please provide further detail
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Please outline the countries or regions where your product is most applicable
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Please list management's qualifications or past experience that is relevant to this venture
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Does the venture have affiliations to research, a university or a university ecosystem?
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Yes
No
If Yes, please provide further details
What is the global challenge that your product aims to solve?
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What is your solution?
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Describe your competitive advantage and any barriers to entry in your respective market
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Describe the size of your potential market
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Describe your business model
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Describe your "go-to-market" and sales strategy
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Describe your operating risk and strategy
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List any existing or potential customers
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What is the current financing stage of your company?
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Angel
Series A
Series B
Series C
Series D
Growth
List any affiliated investor/investing institution, financing amount, percentage of equity and the date of the investment
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Estimated pre-money valuation
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Less than £1 Million
£1 - 10 Million
£10 - 50 Million
£50 - 100 Million
£100 - 200 Million
£200 - 500 Million
£500+ Million
Please state your forecast main business revenue:
2017
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2018
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2019
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Please state your forecast main business costs:
2017
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2018
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2019
*
Please state your forecast main business profit:
2017
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2018
*
2019
*
Please state your forecast main business profit margin:
2017
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2018
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2019
*
Please state your forecast net profit:
2017
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2018
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2019
*
Please state your forecast burn rate:
2017
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2018
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2019
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Does you company hold any specific IP
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Yes
No
Please fill in your core technology details:
Name of Patent
Patent Number
Date Obtained
-
Month
-
Day
Year
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Country
What is the Type of Patent?
Invention Patent
Utilitarian New Type Patent
Exterior Design
Does your company hold any Software Copyright?
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Yes
No
Please fill in your Software Copyright details:
Name of Software Copyright
Application Country
Owner of Software Copyright
Registration Number
Date Obtained
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Month
-
Day
Year
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