NIDHI – PRAYAS Programme
of
Department of Science and Technology, Government of India
National Science and Technology Entrepreneurship Board (NSTEDB)
PRAYAS - Individual Innovator Application form
Latest Photo (not less
than 6 months)
1. Title of the proposed project:
2. Innovator Details:
2.1 Personal Details
a. Name of the Innovator :
b. Father’s name/Husband’s name:
c. Date of Birth: (dd/mm/yyyy)
d. Email ID:
e. Mobile Number:
f. Landline Number:
g. Gender:
h. Educational Qualification:
i. Category (General/SC/ST/OBC/Others :
j. PAN Card no (mandatory):
k. Aadhaar No (mandatory):
l. Address : (Please enclose residence certificate issued by Sub-Divisional
Magistrate(SDM)/District Magistrate(DM) or a copy of ration card or any other document
regarding proof of Residence)
Postal Address Permanent Address
2.2 Professional Details
a. Profession of the Innovator:
b. Name & Address of the Institution/Organization (applicable in case of Innovator in Employment /
Students with any R& D organisation / Academic Institution:-
c. For Innovator in Employment / Students with any R& D organisation / Academic Institution No
Objection Certificate Upload NOC from Head of Institute /Organization is mandatorily required)
d. Annual Income of the applicant (applicable in case of Innovator in Employment) :
(attach a copy of the latest Income Tax Returns filed)
e. Have you started your own venture (start up) ? Yes / No ----
If yes, please mention the following
Name of your start up
Your Role in start up (eg. CEO, COO, Product Head etc)
Date of Incorporation
Revenue generated till date –
Provide Cap structure of the startup -
Sr No. Name (Founder/Co-founder) Nationality Commitment (Part % share
time/ Full time) holding
2.3 Team Member Details (NOTE: If no team members, kindly mention NA in column Name)
Sr No. Name Aadhar No. Pan Gender Contact Email-id Qualification
Card
no.
3. Brief description of the idea highlighting innovative element.
4. (a) Status of work already carried out (if any) such as. Please tick ✓ as applicable.
Idea level
College Project
Lab level – Proof of Concept
Paper Presentation
Working Prototype ready
(b) Science and working principle behind the idea
(c) Final outcome/deliverable of the project
(d) Who would be the beneficiary of this innovation and why?
(Please use a separate sheet)
5. Proposed costs and time frame
[Link] Items Project Cost PRAYAS support
Own Share sought
1. Outsourcing Charges for R&D/Design
Engg/Consultancy/Testing/Expert cost
2. Raw material/ Consumables/Spares
3. Fabrication /Synthesis charges of working
model or process
4. Business Travel and Event participation
Fees (Ceiling 10% of approved project
cost)
5. Patent filing Cost – (PCT- Ceiling 10% of
approved project cost)
6. Contingency - (Ceiling 10% of approved
project cost)
Project period in months: ________________________
(Not more than 12-14 months)
6. Activity details/work plan
[Link] Activities Monitorable Duration (months)
Milestones
7. Have you received financial support / award for your present work from any other sources? (if so,
please furnish details)
8. Have you also applied / in process of applying to any other PRAYAS Centre (s) for NIDHI-PRAYAS
and/or NIDHI-EIR grant -- Yes/ No
If Yes – Please mention the name of the Centre / TBI and the program.
9. Have you been approved / received the NIDHI-PRAYAS -- Yes/ No
If Yes – Please mention the name of the Centre / TBI and Date of approval/Funds received
8. Essential Criteria
Applicant Confirms that he/she has not been a Yes / No
recipient of any NIDHI-PRAYAS or similar
support previously for the same innovative
concept as proposed in this form. NIDHI-
PRAYAS can be used only once.
Applicant is planning to pursue NIDHI- PRAYAS Yes/No
full time with no other concurrent commitments
Applicant confirms that he/she is fully committed Yes/No
to work towards the prototype development for
which the support is being sought and should not
treat this as a stop gap arrangement to support any
other pursuits
Applicant has or is planning to register for the pre Yes/No
incubation or incubation program at the TBI for
the entire duration of PRAYAS support
Applicant confirms that if selected for NIDHI- Yes/No
PRAYAS, then they (applicant and their team
members) will avail support for their project from
only one PRAYAS Centre. If the applicant is
found seeking NIDHI-PRAYAS support for the
same idea from two different PCs, then the PC
reserves right to discontinue the PRAYAS support
and appropriate action will be taken on the
applicant.
Applicant confirms that they will not avail the Yes/No
funding support in parallel for both the schemes
i.e NIDHI-PRAYAS and NIDHI - EIR from the
same or different centers.
10. Declaration:
I declare that all the statements made in this application are true, complete and correct to the best of my
knowledge and belief. If any information is found false or incorrect, my candidature will stand cancelled
and all my claims will be forfeited. I have not received any financial assistance for the present proposal
from any other agency.
Place: Signature of the applicant
Date:
