Please, fill out this application and send it to [email protected] to participate in
the selection process to pitch at Startup India Rocks!
The more detailed your application the better your chances are of being selected.
COMPANY
Company Name:
CEO name:
Contact details:
Brief Company
Description (Maximum 2
lines!):
What problem do you
solve?
Industry:
(Please, mark your
industry with an “X”)
Date of incorporation:
City and Country:
Website Address:
Stage of the company:
Milestones to date
(briefly explain your
milestones to date. We
have provide you with
some examples to help
you.
PRODUCT
Product/s Name, and
Brief Description





Email:
Phone (and country code):
Skype ID:
Twitter:
Linkedin:
__ Mobile __ Mobility
__ SAAS
__ Marketplaces __Social Media __ High Tech
__ Real Estate __ Consumer Products __Internet __ Service providers
__Telecommunications __Media __Energy __Healthcare __Medical Devices __Biotech
__Legal __ Big data _E-commerce __Others: (please, specify)
__ Seed (I have a prototype, but I haven’t gone into the market yet or I have gone but I don’t
have any traction yet)
__ Start Up (Company with some traction in the market, with or without revenues)
__ Growth (Company with traction, revenues and more mature stage)
__ Prototype (When:
__ Tech development (When:
__ Beta testing (When:
__ Team in place (When:
__ Launch (When:
__ First Traction (When:
__ First Client (When:
__ Creating client base (When:
__ Internationalization (When:
__ FFF Round (When:
__ Patent (When:
__ 1st Round of Capital (When:
__ Others:
Who are your
competitors?
Why are you
different/better option
than the rest?
Barriers to Entry /
Intellectual Property
Risk Factors
Monetizing Strategies
(Business model. How do
you make money?)
__ Selling your product / service
__ Licensing & franchising
__ Affiliate marketing
__ Subscription model or membership fee
__ Freemium
__ Direct Add
__ Pay per View access to document
__ CPM display advertising on site
__ CPC advertising on site
__ Sponsorship of site sections or content type
__ Subscriber data access for email marketing
__ Sponsorships
__ Grant
__ Other:
FINANCIALS
Some Numbers (Specify
Currency used : US$,
Euros)
2015
2016 Actuals
(till date)
2016
2017
2018
Forecast
Forecast
Forecast
Revenue
Expenses
Profit
Monthly Burn Rate
Cap table:
INVESTOR
AMOUNT
TOTAL
Pre/Post Valuation, Basis:
(Specify Currency used:
US$, Euros)
How much capital do you
need for this round?
Use of new Funds
(indicate percentage for
every case)
Pre-Money Valuation (current):
Valuation Method:
Post-Money Valuation (after next round):
Valuation Method:
__ Marketing & Sales
__ Product Development
__ Hiring team
__ Internationalization
__ IP, Patents, legal
__ Covering debt & restructure
SHARES
%
xx
100%
__ Founders salary
__ Setting a new office / retail / manufacturing / warehouse
__ Capital equipment
__ Supply chain
__ M&A
__ Working capital
__ Others:
Are previous investors
participating in this
round?
__ Yes If YES, how much do you have committed from them? :
__ No
MANAGEMENT
Key bios (provide relevant
information for every
team member or advisor)
MARKETING & SALES
Go To Market Strategy
How many clients or
users do you have to
date?
Who is your client?
__ No clients yet
__ No users yet
__ From 1 to 50 clients/users
__ From 50 to 100 clients/users
__ From 100 to 500 clients/users
__ From 500 to 1,000 clients/users
__ From 1,000 to 5,000 clients/users
__ From 5,000 to 10,000 clients/users
__ From 10,000 to 50,000 clients/users
__ From 50,000 to 100,000 clients/users
__ From 100,000 to 500,000 clients/users
__ From 500,000 to 1,000,000 clients/users
__ From 1,000,000 to 5,000,000 clients/users
__ Over 5,000,000 clients/users
__ B to B:
__ SMB companies
__ Big Corporations
__ Government and public administration
__ Others:
__ B to C:
__ Youth
__ Kids
__ Women
__ Men
__ General Public
__ Geeks
__ Others:
Sales Channels
Pipeline (Who/Amount)
Market Size (what is your
market? How big is it?)


Target Countries:
Size of the market:
EXIT STRATEGY
What’s the exit strategy
Timing for your exit
__ Acquisition
__ IPO
__ MBO
__ Other:
__ 1 to 3 years
__ 3 to 5 years
__ 5 to 7 years
__ 7+ years
Example of Potential
acquirers. Who could buy
your
company/technology?