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Second phase of registration has started from 21-09-2017
Note : All fields are mandatory.
A. Company Information
A.1 Name of company (Start-ups which are Not-for-profit are not eligible):
*
A.2 Registration Information:
i) Place of registration:
*
ii) Date of Registration:
*
iii) Registration No.:
*
A.3 E-mail, website:
*
A.4 Mobile Number:
*
A.4 Office Address:
*
A.6 Turnover in Rs Crores for last five years of the Company:
i) Turnover for 2016:
*
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
ii) Turnover for 2015:
*
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
iii) Turnover for 2014:
*
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
iv) Turnover for 2013:
*
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
v) Turnover for 2012:
*
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
Less than 10 lakhs
Between 10 and 50 lakhs
Less than 1 crore
Between 1 and 10 crores
Between 11 and 25 crores
Above 25 crores
A.7 Confirm that company / entity has not been formed by splitting up or reconstruction of a business already in existence:
*
B. Founders Information
B.1 Name of founders
*
B.2 Nationality
*
Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle Of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Martin
Saint Pierre And Miquelon
Saint Vincent And The Grenadines
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia And The South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Democratic Republic Of Congo
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis And Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle Of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Martin
Saint Pierre And Miquelon
Saint Vincent And The Grenadines
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia And The South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Democratic Republic Of Congo
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis And Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
B.3 LinkedIn profile/ Website URL
*
B.4 Email
*
B.5 Mobile
*
B.6 Address
*
B.7 How long have the founders known one another? How did they come together?
*
B.8 What are the domains of expertise of the team members?
*
B.9 Do you have a founder’s agreement in place?
*
Yes
NO
B.10 Can the founders be in Mangalore?
*
Yes
No
B.11 Identity proof (To be submitted later)
C. Idea & Area of Business
C.1 What sector does your idea / startup belong to?:
i) Select a Category:
*
Select
Automation / Robotics in hydrocarbon scenario
Business process / re-engineering software / IT related and logistics related development
Cost Optimization solution - Storage / Logistics / Usage / Packaging
Development of Business Analytics
Development of device for cracks / leak detection in pipelines
Gas/ liquid leak detection and protection system
Improved Asset Utilization
Innovative scheme for zero effluent in refineries
Innovative storage solution - Energy, Petroleum Products, Lubes, Base Oils
Innovative waste disposal
Inventory Management - Crude and Petroleum Products
Low Cost Model for Waste to Energy
Low cost fuel quality monitoring and onsite detection device/s
Low cost on-site lube condition monitoring techniques
Low cost process for desalination of sea water
Manufacturing of Nano Materials/Catalysts / Chemicals
Manufacturing of biofuels including Ethanol
New applications with refinery streams
Other open areas related to petroleum refining and alternate energy
Reduction in emissions
Replacing the heat source in refineries by renewables
Others
Select
Automation / Robotics in hydrocarbon scenario
Business process / re-engineering software / IT related and logistics related development
Cost Optimization solution - Storage / Logistics / Usage / Packaging
Development of Business Analytics
Development of device for cracks / leak detection in pipelines
Gas/ liquid leak detection and protection system
Improved Asset Utilization
Innovative scheme for zero effluent in refineries
Innovative storage solution - Energy, Petroleum Products, Lubes, Base Oils
Innovative waste disposal
Inventory Management - Crude and Petroleum Products
Low Cost Model for Waste to Energy
Low cost fuel quality monitoring and onsite detection device/s
Low cost on-site lube condition monitoring techniques
Low cost process for desalination of sea water
Manufacturing of Nano Materials/Catalysts / Chemicals
Manufacturing of biofuels including Ethanol
New applications with refinery streams
Other open areas related to petroleum refining and alternate energy
Reduction in emissions
Replacing the heat source in refineries by renewables
Others
ii) Briefly describe sector on which your startup belong:
*
C.2 Why did you choose this startup? What is the need you are addressing for your end user?
*
C.3 Please describe the product you are developing, in a non-confidential manner:
*
i) Technology
*
ii) Who will use your product?
*
iii) Who will pay for your product/service?
*
iv) What is the market price of your product/service?
*
v) Do you have intellectual property right (IPR) of your own covering your product concept? If then what is it?
*
vi) Do you have freedom to operate (with respect to intellectual property) in India?
*
C.4 What is the current status of your product?
*
C.5 Briefly describe the market for your product, trend and size
*
C.6 Who are your competitors, how are you different, competitive advantage and who might be a potential competitor?
*
C.7 Provide a link to short video demo/slide deck with photos describing of your product
*
C.8 Whether the proposal is already selected under Startup India Scheme?
*
Yes
NO
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