For Commercialization of Viable Products

Application form

For Commercialization of Viable Products

in Khyber Pakhtunkhwa

Under the Development Scheme of DoST

“Promotion & Development of Science & Technology in KP”

DIRECTORATE OF SCIENCE AND TECHNOLOGY

Government of Khyber Pakhtunkhwa

TF: 250 3rd Floor, Deans Trade Center Peshawar Cantt

091-9212881, 9212583, 9212676, 9212413, 9212254

http://www.dost.gov.pk

Project Checklist

Please submit this completed checklist along with your proposal. Incomplete proposals may not be reviewed.

o Application Form signed by the main applicant and head of organization

o Company Registration Certificate (for private businesses only)

o NTN Certificate (for private businesses only)

o Domicile of main Applicant

o Proof of physical location of the business in KP (faculty members can apply through their academic/research institutes)

o Link to a max 2 min video of the working prototype (A CD with video of the working prototype should also be provided)

o Evidences of any awards or achievements (if any)

o CVs of key personnel involved in the project

o Business Plan

o Budget of the project showing cash flows and income statement

1. Proposal Details

Name of Business:
Project Title:
Estimated Start Date of the project:
Project Duration (months) :
Total Project Cost:
Funding requested from DoST (90 % of the project cost):
Other funding(s): (10 % of the project cost):
Website of the project (if any):
Website link to a 2 minutes video showing working of the already developed prototype:

Is the prototype of your proposed project already developed?

Yes □ No □

Technology area(s) to which this projects is related (select all those apply to your project):
o / Agriculture & Food / o
o / Energy / o
o / Health / o
o / Environment / o
o / Other (specify): / o

2. Main Applicant(s) Information

First Name: / Middle Name:
Last Name: / Title:
Position/Title:
Business/Institution Name:
Business/Institution website:
Department:
Street Address:
City:
Province: / Country:
Phone Number: / Fax Number:
E-mail Address1: / E-mail Address2:

Co-Applicant(s) (if any) Information

First Name: / Middle Name:
Last Name: / Title:
Position/Title:
Institution/Business Name:
Department:
Street Address:
City:
Province: / Country:
Phone Number: / Fax Number:
E-mail Address1: / E-mail Address2:

By signing this application, I/(We) certify that the information provided herein is true, complete and accurate to the best of my knowledge. I/(We) assure you that the Grant amount will be used only for the purpose and project in questions in accordance with the terms and conditions as per signed agreement. In case of misuse of funds, the entire Grant amount, if received, will be liable to be repaid and in case of remaining tranche(s) the grant shall be seized and amount will be repaid immediately.

Main Applicant Signature / Date / Co-Applicant (if any) Signature / Date

3. Main Applicant’s Business/Institution:

CEO/Director/Head of Institution/Vice-Chancellor:
First Name: / Last Name:
Position/Title:
Business/Institution Name:
Phone Number: / Fax Number:
Signature / Date Signed:

Partner 1 (if any):

CEO/Director/Head of Institution/Vice-Chancellor:
First Name: / Last Name:
Position/Title:
Business/Institution Name:
Business/Institution Address
Phone Number: / Fax Number:
Signature: / Date Signed:

Partner 2 (if any):

4. Executive Summary (Max One Page)

This should be a brief, public facing description the project using language that can be understood by people without specialist knowledge or expertise. It should explain why the project is innovative and describe the key aims and objectives. Whilst this section is not assessed, provision of this executive summary is mandatory. This section helps the assessor and management to get a quick idea of the proposed project.

5. Achievements/Traction Obtained so far (one page max).

Please provide details of any traction related to this project, that you have received so far. These include demand shown by customers or end users. You can also include details about previous funding achievements, patents, awards, letters of appreciation, media coverage or other details relevant to the proposed project.

6. Project Details:

6.1 What is the business opportunity that this project addresses? (Maximum 3 pages)

Discuss the problem that this project aims at solving. Also show the limitations of the state-of-the-art and justify that existing solutions cannot solve the problem highlighted in this proposal. You do not need to give detailed description of the each of the existing solutions. Only highlight their limitations and that why they cannot provide a solution to the problem.

6.2 Technical Details (Maximum 5 pages):

Provide the technical details of your product. Provide any flow charts, block diagrams and other details that show the working of your system. You must also provide a link to the video of the working of the system. You must also be able to demonstrate the working of the prototype when required by the evaluators.

6.3 Innovation/Unique Selling Points - USPs (Maximum 2 pages)

How is your developed project providing a solution to the problem highlighted above? Give the Unique Selling Points (USPs) of your developed solution:

6.4 Size and Nature of Market (Maximum 2 pages):

What is the size and nature of the market opportunity that this project targets? (Maximum 2 pages)

6.5 Market Demand/Customer Validation (Maximum 2 pages):

Show any evidence of market demand for your product. This can be in the form of a market survey, expression of interests shown by potential businesses, end users interests or customer validation.

6.6 Business Model (Maximum 08 pages):

Your business model should focus more on the business strategy. You must include sections on proposed strategy (route to market), revenue model, pricing etc. Provide any other details that justify the strength of the project, the projected sales figures and that the business has a strong commercial potential

6.7 Projected Revenue Generation (Maximum one page):

Based on your financial projections (to be provided separately in the budget file) how much is the projected 3 years revenue generated as a result of this project? What will be the sales value of the business at the end of Year 3?

6.8 Benefits (Maximum 2 pages)

Provide details of all the benefits of the proposed project. These benefits can be economic opportunities, social and environmental benefits, job creations or other public impact.

7. Project Management:

7.1 Team Structure (Maximum 2 pages):

Briefly show the relevant expertise of key personnel involved in this project.

7.2 Project Plan (Maximum 6 pages)

Provide Gantt Chart, Work Packages and detailed tasks. Discuss the different aspects related to project management in this project.

7.3 Key Milestones and Deliverables (Maximum 2 pages)

Please list and describe the key milestones and associated deliverables of the project. A key milestone is reached when a significant phase in the project is concluded. Quarterly deliverables are preferred.

7.4 Risks and Contingency Plan (Maximum 2 pages)

What are the risks (technical and commercial) to project success? What are the risk management and contingency plans to mitigate risks? Identify the key risks and uncertainties of the project and provide a detailed risk analysis for the project content and approach, including the technical, commercial, managerial and environmental risks as well as other uncertainties (e.g. ethical issues) associated with the project. The main risks should then be rated as High/Medium/Low (H/M/L). Also state how the project would mitigate these key risks. (Maximum 2 pages)

8. Profiles of Project Members:

8.1 Profile of Applicant’s Organization/Business (Maximum one page):

Provide details of the specific expertise and track record of the applicant’s business. Include any achievements or awards that confirm the involvement of the business into highly innovative businesses and research activities with focus on commercial impacts. Proof of business activity should also be provided.

8.2 Maximum one page profile of each partner (if applicable):

9. Financials:

9.1 Budget File

Provide 3 years budget plan for the project. Your budget plan must include the following:

· Equipment

· Human Resource

· Travel

· Boarding & Lodging

· Income Statement

· Cash flow for 3 years

· Income and Profit for 3 years

9.2 Details about budget Plan - optional – (Max one page):

Use this section to provide any details about the budget file provided separately in the above section.

9.3 Financial Support from other sources:

Have you received any public or private funding for this project?

Yes □ No □

If yes, please identify the funding agency and amount:

10. References (Local market references)

Please list the name and phone numbers of two references who are familiar with the applicant’s work relevant to this application. The Board may contact these references.

a. Name ______

b. Address ______

c. City ______

d. Phone ______

a. Name ______

b. Address ______

c. City ______

d. Phone ______

Note: Three (03) copies of the proposal must be delivered or mailed at the above cited address

11. Other Files:

The following documents/files should be submitted in addition to this application form:

· Expression of Interests / Letter of Intents (if any) showed from potential distributors or related businesses

· Survey/Feedback forms filled from end users (if any)

· Letters of appreciation DEMAND from THE REELVANT industry/ ies experts (if any)

· Evidence of any awards or achievements (if any)

· Company registration certificate (Required for private businesses).

· NTN certificate of the private business

· CVs of main applicant, Project Manager Director, Co-Project Manager Director and Team Leads involved in the project. Please do not include lengthy publications lists, or copies of publications as they will not be forwarded to reviewers

If you need further assistance or information on the application process, please contact on the following details:

Note. Government can claim some of the equity against its investment. The revenue generated will be contributed to S&ICT endowment fund.

Address: TF: 250 3rd Floor, Deans Trade Center Peshawar Cantt;

Phone: 091-9212881, 9212713,