ON LINE Application Form
For availing financial assistance under 'Venture Capital Fund for SCHEDULED CASTES'


1. Particulars

Application for *
Constitution of the business *
Enter name of the Appliciant / Entity *
Is there a company in Existence
Enter name of company
Eligiblity under ASIIM /Technology oriented innovative projects
List of TBIs Department of Science and Technology
other please Specify
Address of TBI/Incubator
Contact Details of the Head of TBI supported by DST / Incubator
Name Designation Contact Email
Promoters Details
* * *
Sector *
Industry
Registered/Corporate Office
* *
Company/ Office Phone No
Year of incorporation
*
Existing Banker
*
Email of company *
Details of Existing Business

2. Shareholding pattern of the company (Past Financial Year)

*
    DD/MM/YYYY
Salutations Name Number of Shares being held % of share holding Whether belongs to sc Category
* * * * *
Total Total

Shareholding pattern of the company ( Latest )

*
    DD/MM/YYYY
Salutations Name Number of Shares being held % of share holding Whether belongs to SC Category or not
* * * * *
Total Total

3. Project Details:

Status of Project: *
Proposed Project Location *
Brief About Project *
Project Cost (Break up Details) Note: It will be Rs. 10 lakh p.a and maximum Rs. 30 lakh over 3 years:
Particulars In Rs. Lakhs
TBI accommodation cost
Hardware
Software
Fellowship
Travel and Marketing
IP filing
Tool room expenses
Co workers ( @ Rs. 20,000 p.m. per worker)
Others
Total Cost of Project
Means of Finance (Break Up Details):
Particulars In Rs. Lakhs
Proposed Contribution by promoters
Funds requested from Venture Capital Fund for Scheduled Castes
Banks/FIs
Total Means of finance
Following list of documents are required to be submitted along with Reference Application No. to IFCI Venture at following address:
IFCI Venture Capital Funds Limited
(Investment Manager – Venture Capital fund for Scheduled Castes)
IFCI Tower, 16th floor, 61 Nehru Place, New Delhi- 110019.













* Disclaimer: I/we agree that, I/ we have read the scheme documents uploaded in the website and understood the entire eligibility criteria and scheme details. I / We hereby declare that the information submitted by me / my company is correct and true. I/ we understand that, the submission of this application form is not construed as any approval / sanction for the financial assistance requested from Venture Capital Fund for Scheduled Castes.