This is a Youth Technology Innovation Fund application form. The youth targeted is between
the ages of 18 to 30 not already funded through the Youth Technology Innovation Fund or
any other TIA funding instruments. The form is to be completed and emailed to
[email protected]; or Fax to 086 644 8756.
Note:

This form should preferably be completed on the computer.

Kindly answer ALL questions within the specified number of words.

Please provide as much detailed information as possible to allow YTIF
assessors to better understand your idea.

Received proposals will be evaluated based on technical as well as commercial
merits.

Please DO NOT alter the numbering.

Incomplete application forms will not be considered.

This form should be submitted in a PDF format.
Below are some of the funding options you may qualify for:
Vouchers
SABS services for product certification (up to R100 000)
Incubation services at a recognized TIA partner organizations (up to 2
years)
Business Coaching services (160 hours)
Use of TIA Technology Stations and Platforms services (up to R250 000)
Intellectual property protection (up to R150 000)
Allowance granted for up to 4 inventors for 2 years (R60 000 per person per
annum).
Personal Details
Title of the
Proposal
Name of the
Lead Applicant
Contact Details
Mobile Number:
E-mail Address:
Website
Province
Current
(currently
Physical
located)
address
Geographic
Urban
Rural
location
Suburb
Media
Internet
Word of
Township
Farm
Institution
TV
Village
Newspaper

Beeld
become aware of

Express Northern Cape
TIA Youth

Isolezwe
Technology

Star
Innovation

Sunday Times
Fund?

Daily Despatch
(mark with an x)

Mpumalanga News

Restenburg Herald

Cape Argus

Free State Times
How did you
Specify name of
media
mouth
Screening Information
Mark with a
Screening Questions
(X)
Yes
No
Yes
No
Yes
No
Yes
No
Are all the applicant(s) between the ages of 18 and 30?
Have you or your team receive any form of funding from TIA before?
Are all applicant(s) SA Citizens or have SA Permanent Residency?
ID copies and/or proof of SA Permanent Residency should be attached
Does your application include the promotion of recreational drugs, liquor, and
gambling or sex trade?
Page 2
Technology Innovation Description
1. Brief description of the idea/technology
Explain, using between 300 and 500 words (The total number of words for the answers of
1.1 to 1.7 must sum up to between 300 and 500 words)
1.1 Who came up with the idea for the invention?
<Please type response here>
1.2 Is the proposed product at the idea stage, prototype, fully developed or already being
manufactured? (Attach pictures and drawings, details of the prototype testing)
<Please type response here>
1.3 What is the concept/product to be developed?
<Please type response here>
1.4 Describe the projects (5 -10 sentences). Specifically mention the technology
(product/process/service) that either has been or is still to be developed.
<Please type response here>
1.5 Briefly describe the identified problem and how the proposed technology/ product will
address the problem.
<Please type response here>
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1.6 What is the uniqueness of the product? Provide a brief description of HOW unique
and/or innovative your concept/ product is.
<Please type response here>
1.7 What are the benefits of the innovation?
<Please type response here>
2. Target Market and Competators
Explain, using between 300 and 500 words (The total number of words for the answers of 2.1
to 2.6 must sum up to between 300 and 500 words)
2.1 Who are the people that have this problem/need and are likely to pay to have it
solved?
<Please type response here>
2.2 Are there any currently a similar idea/product existing in the market, and/or potential
competition idea/product? If yes, what are the features that your product has over
competitors to make your product superior and set it apart from the competitor
products?
<Please type response here>
2.3 How compatible is your idea/product with the existing systems (if required) in which it
will be applied or used?
<Please type response here>
Page 4
2.4 Is your offering/ product targeting the local and/or global market?
<Please type response here>
2.5 What are the risks that can hinder the success of the concept/ product?
<Please type response here>
2.6 What market need/opportunity does the idea intend to address?
<Please type response here>
3. Intellectual Property
3.1 Is there registered Intellectual Property related to the concept/ product. If so, provide
details
<Please type response here>
3.2 Provisional Patent Description
<Please type response here>
Page 5
4. Funding Objectives & Motivation
Explain, using between 50 and 100 words (The total number of words for the answers of
4.1 to 4.2 must sum up to between 50 and 100 words)
4.1 By applying to TIA for funding, what objective(s) do you hope to achieve?
<Please type response here>
4.2 Identify the sector into which the project falls: Mark with an (X)
Industrial Sector
Biotechnology Sector
Advanced Manufacturing
Health
Energy
Agriculture
ICT
Industrial Biotechnology
Mining
Other
*please follow this link http://www.tia.org.za/sectors for more information
regarding the sectors
5. Impact
Explain, using between 200 and 300 words (The total number of words for the answers of
5.1 to 5.2 must sum up to between 200 and 300 words)
5.1 What is the potential impact of your idea/product (solution) in terms of:
(i) Society
<Please type response here>
(ii) Economy
<Please type response here>
(iii) Capacity Development
<Please type response here>
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5.2 Will the idea be contributing to development of scarce skills that will be of value to the
targeted industry now or in the future?
<Please type response here>
6. Background Information
6.1 What, if any, job are you currently doing?
<Please type response here>
6.2 How is your business intended to operate? (individual, sole trader, partnership, Closed
Corporation, Private Company ((Pty) Ltd Company), joint venture, etc.?)
<Please type response here>
6.3 Have you received /applied for funding support from other government institution?
If yes, please specify below
<Please type response here>
7.
Team competency and ability
7.1.
Which of your core competencies/skills can be used towards the development of your
idea/product?
<Please type response here>
7.2.
Have you (or your team) previously been involved in invention and/or product
development and/or commercialisation of products? If yes, please provide details.
<Please type response here>
Page 7
Innovation Individual or team members*
Indicate the names and qualification of the individual and/or team members who will be implementing the proposed idea/product.
Title
Name
ID No
Cell Number
Email Address
Qualification
Currently
Employed?
(Yes/No)
Disability Race
(Yes/No)
*The innovation team members must be between the ages of 18 to 30. Please attach certified ID Copies or proof of SA Permanent Residency
for all Innovation Team Members. Please Do Not include mentors on this table.
Page 8
Mentors Table
Title
Name
ID No
Cell Number
Email Address
Qualification
Currently
Disability Race
Employed?
(Yes/No)
(Yes/No)
Page 9