Startup Registration Form

Annexure-2 · Startup Odisha (practice copy)

Annexure-2: Startup Registration Form (recognition - prerequisite for all benefits)

Incorporation Number *

Incorporation number would be verified through MCA-21 portal, where applicable (CIN / LLPIN; firm registration no. for partnerships).

Sector (To be selected from the drop down box)

Drop-down values are the industries in Annexure-13 'List of Sectors'. Each industry has sub-sectors (e.g. Agriculture > Dairy Farming, Organic Agriculture, Agri-Tech, Food Processing, Cold storage; Healthcare & Life sciences > Medical Devices/Biomedical, Health & Wellness, Pharmaceutical, Healthcare IT). Sub-sectors are not transcribed here.

Date of Incorporation

Must be within 7 years (10 years for Biotechnology).

Entity's Name

Entity's Address

Registered address. An Odisha address, or the Odisha workforce nexus, is needed.

Entity's Website URL

Focus Area : Product / Service Product Service

Incorporation Structure (To be selected from the drop down box)

'Limited Liability Company' on the form corresponds to a Limited Liability Partnership under the LLP Act 2008, per the policy definition of Entity.

Director's / Promoter's Name, Gender, Caste & Shareholding percentage (All directors)

One director per line: Name | Gender | Caste | Shareholding %

Director's / Promoter's Mobile Number (Main & alternative)

Director's / Promoter's Email Id (Main & alternative)

Self-Declaration (Tick appropriate ones)

All four must be ticked to qualify as a Startup.

Date of incorporation / registration of entity is not prior to 7 years. In case of Biotechnology Startups incorporation/ registration should not be prior to 10 years. The entity's annual turnover does not exceed Rs.25 Crore, for any preceding financial year. If not registered in Odisha, the entity employs at least 50% of its total qualified workforce in Odisha. The entity is not an extension of the existing family business; or formed by splitting up or reconstruction of a business already in existence.

Brief description of product & innovation:

No limit printed. The Nodal Agency's expert committee reviews it for innovativeness. Policy definition of Innovation: translating an idea or invention into a good or service that creates value for which customers will pay. The work should be technology- or IP-driven and scalable.

Innovation Proof (Tick the appropriate one) DIPP Startup India recognition certificate; OR Patent filed in its company name and published in the Journal by the India Patent Office in areas affiliated with the nature of business being promoted; OR Sanction Letter of funding / Grant to the entity/ Founder/ Co-Founder by Government of India or any State Government (Either directly or through third party implementing partner) as part of any specified scheme to promote innovation; OR Letter of funding of not less than 20 percent in equity by any Incubation Fund/ Angel Fund/ Private Equity Fund/ Accelerator/ Angel Network duly registered with Securities and Exchange Board of India that endorses innovative nature of the business; OR None of the above.

In case of none of the above, a note on Innovativeness (not more than 2 MB size) to be attached.

Guidelines: a one-page write-up / note explaining the innovative nature of its product. The applicant is encouraged to share its business plan along with the note.

Are you already an Incubatee? If Yes, write the name and contact details of the Incubator.

Startup Registration Form

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