Shizim Accelerator Application Form
Please fill-in the following form in English and send to [email protected]
Application Date
Organization Background
Company Name
Year Established
Full Address
Website
No. of Employees
No. of R&D Personnel
Project Title
The Problem
The Solution
Innovation & Advantages
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Shizim Ltd.
22 Hamelacha St. P.O.Box 11372, Rosh Ha'ayin, 48091 Israel | Tel: +972-3-9002000 | Fax: +972-3-9022954 | www.shizim.com
IP Status
Market Potential
Company Current Status
Do you have an initial regulatory plan?
Yes
No
If yes, please describe your Planned Regulatory Strategy
Do you have an initial reimbursement plan?
Yes
No
If yes, please describe your Planned Reimbursement Strategy
Team Members
Roadmap - Milestones to Commercialization
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Shizim Ltd.
22 Hamelacha St. P.O.Box 11372, Rosh Ha'ayin, 48091 Israel | Tel: +972-3-9002000 | Fax: +972-3-9022954 | www.shizim.com
The Resources Needed
Investment required for next round:
Additional investments in future rounds
until product commercialization:
Amount invested in the company to-date:
Company valuation for next round
Company's Shareholders
Shareholder Name
%
Shareholder Name
%
Contact Person Data
Last Name
First Name
Function
Title
E-mail
Mobile
Direct Telephone
Fax
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Shizim Ltd.
22 Hamelacha St. P.O.Box 11372, Rosh Ha'ayin, 48091 Israel | Tel: +972-3-9002000 | Fax: +972-3-9022954 | www.shizim.com