TPF Application Form

1. Title of the proposed Project:

2. a) Name of the Applicant:     

b) Father's / Husband's name :  

c) Postal address:                      

d) Nearest Railway Station &

District Headquarters:                

e) Profession of the applicant (Please tick as applicable and explain your present source of income. Use prescribed format)

:

Technician Engineer Architect ArtisanDoctor
Scientist Housewife Student FarmerOther

f)Date of birth :
                       Day : Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Month : Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Year: Select 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
g) Educational Status:

Select Illiterate Upto 10th Stanadard Matriculate HS or Equivalent Graduate Masters Other

h) Experience / Employment status of the applicant:


(if employed in industry or in any other organization, 'No Objection Certificate' from the employer is to be enclosed. Use prescribed format)

i) Annual Income of the applicant:


(If you are an Income Tax Payer, please provide Your PAN No. and attach a copy of the latest Income Tax Returns you filed)

3. Brief write-up giving broad details of the original idea/ invention/ IPR/ Know how available with the individual(s), highlighting its originality/Novelty and the
scientific principle involved therein (Please use Technology Angels evaluation form. Fill left column. And enclose as Annexure -II)

4 .Status of the work already carried out (if any) such as;

Literature survey/patent search

Development work done so far, if any, including involvement of agencies,
consultation with experts, please give details including IPR generated or ownership thereof.

Patenting of the innovation

Sponsored subcontracted work with any external agencies,

Techno-economic / market feasibility studies /reports, if any,

Consumers / users feedback, if any.

(Enclose documentary proof of work done by way of photographs, video clips etc. Enclose as Annexure-III)

5.(a) End product / process / output-resulting from the idea/ invention/ innovation
(including targeted specifications, performance requirements/standards it is expected to meet. Enclose as Annexure IV)



(b) Potential major applications and users :