China-Korea

Industrial Technology R&D Cooperation

Application Form

Submission Date:

Contact Person: (name) (tel) (cell) ______

1. General Information
1.1 Project Title (Do not exceed 120 characters)
1.2 Summary / (Do not exceed 240 characters)
1.3 Main Technological Area
1.4 /

OrganizationName

/

Role of Participant

/

Country

/

Contribution

( %)

/

Budget

($US) /

Duration

(months)
Total budget to the project :
1.5 Start Date
1.6 End Date
2. Project Outline
2.1 Description
(Approximately one A4 page)
2.2 Technological Development Envisaged (Level of innovation)
(Approximately one A4 page)
2.3 Market Potential and Commercialization Plan
2.4 Cooperation Between Participants (synergies, particular advantages, etc.)
2.5 Expected Outcome of Project
2.6 IP Ownership Arrangements

If there are additional "other Chinese participants", please copy the following page

3. Work plan Chinese Participant
3.1 Participant Contact Details:
3.1.1 Organization Name
Full Name
Parent Organization
Type of Organization / SME Large company Other
3.1.2 Organization Address
Street
Zip or Postal Code / City
Country
Telephone / Fax
3.1.3 Contact Person Data
Last Name / First Name
Function / Title
Direct Telephone and Mobile Phone / Fax
E-mail
3.1.4. Website
3.1.5 Organization Background
Year Established
No. of Employees / No. of R&D Personnel
Stage (Seed, Revenue, Pre-Clinical, Clinical)
General Information
Core Business and Area of Expertise
IP
Main Products/ Services
Markets and Customers
Sales (for the Last 3 Years) / Current year (i) / i-1 / i-2
Comments
3.2 Work- Description and Contributions to the Project
3.3 Work Plan and Timeline
3.4 Budget and Resources
3.5 Other Sources of financial Support Related to Proposed Research
Is this, or related research/development, presently being supported by other sources?
If yes, indicate other sources, amounts, and dates of performing of the R&D under this support
Has your company previously received other sources of governmental support ?
If yes, list up sources and dates

If there are additional "other Korean participants", please copy the following page

4. Work plan Korean Participant
4.1 Participant Contact Details:
4.1.1 Organization Name
Full Name
Parent Organization
Type of Organization / SME Large company Other
4.1.2 Organization Address
Street
Zip or Postal Code / City
Country
Telephone / Fax
4.1.3 Contact Person Data
Last
Name / First Name
Function / Title
Direct Telephone and Mobile phone / Fax
E-mail
4.1.4. Website
4.1.5 Organization Background
Year Established
No. of Employees / No. of R&D Personnel
Stage (Seed, Revenue, Pre-Clinical, Clinical)
General Information
Core Business and Area of Expertise
IP
Main Products/ Services
Markets and Customers
Sales (for the Last 3 Years) / Current year (i) / i-1 / i-2
Comments
4.2 Work- Description and Contributions to the Project
4.3 Work Plan and Timeline
4.4 Budget and Resources
4.5 Other Sources of financial Support Related to Proposed Research
Is this, or related research/development, presently being supported by other sources?
If yes, indicate other sources, amounts, and dates of performing of the R&D under this support
Has your company previously received other sources of governmental support ?
If yes, list up sources and dates

The participants signing this form intend to co-operate within the project as described in this form with the aim realizing the technical developments as set forth under point 2. In addition the participants have or intend to put in place, a formal collaboration agreement.

Signature of Chinese Participant
Organization Name
Full Name
Name of Person Signing
Last Name / First Name
Function in Organization
Signature
Signature of Korean Participant
Organization Name
Full Name
Name of Person Signing
Last Name / First Name
Function in Organization
Signature

Page 1 of 7