APPLICATION FORM FOR INCUBATION SUPPORT FOR SEED FUNDING Please Use Capital Letters A GENERAL INFORMATION ABOUT THE APPLICANT Questions 1.1 and 1.3 relate to the individual who is submitting this application 1.1 Your Name 1.2 Your title/ position in the applying team 1.3 Your contacts Physical Postal Tel. No. Fax No. Email Website Questions from 1.4 to 1.11 relate to the team or organisation that will be implementing the project 1.4 Name of lead applicant (company/ team) 1.5 Address Physical Postal Tel. No. Fax No. Email Website Seed funding application form to the UCC Incubation Support Initiative 1.6 Employment (if any) Full-time employees Part-time employees 1.7 For Companies, please provide Company Registration Number and Date (a copy of the certificate of incorporation must be attached) Registration Number Date of incorporation Registered core objective of the business 1.8 For Consortiums/Partnerships: Please provide details of Memorandum of Understanding (MoU)/Partnership Agreement between members 1.9 Describe the extent and form of participation of Ugandan nationals in the team to implement the project 1.10 Total Grant Amount Requested 1.11 How long do you anticipate your proposed project will take to be completed? (in months) Seed funding application form to the UCC Incubation Support Initiative Application Authorisation I confirm that  I am the Principal Applicant for this application and I am duly authorized to sign this application.  To the best of my knowledge, the information provided for this application is complete and accurate and are fully aware that it is an offence to provide false or misleading information  Once I am granted with the funding, I understand and agree that any output of the Incubator will be principally utilized for the development of the communications sector in Uganda Signed Date Questions under Section B relates to your project/idea B INFORMATION ABOUT YOUR BUSINESS PROPOSAL 2.1 What is the name of your project? 2.2 Fundamental concept & business idea summary: please give a background to your business concept or idea in terms of  what need or challenge it addresses,  the number of people affected (or potentially affected) by this need or challenge,  the geographic scale, specific areas or category of population affected by the need or challenge  the relevance of your idea in addressing this need (500 words maximum) Seed funding application form to the UCC Incubation Support Initiative 2.3 What is the product, process or service that the business concept will offer as an output, how does it function and how is it new or innovative? (maximum 500 words) 2.4 At what stage of developing your idea are you? Thought/idea Proof of concept/Testing Research/Theory Product sample Prototype Commercialisation 2.5 How do you plan to commercialise this concept? (100 words) Seed funding application form to the UCC Incubation Support Initiative Questions under Section C relates to your capacity to implement the project/idea C INFORMATION ABOUT THE PROPOSED PROJECT IMPLEMENTATION RESOURCES 3.1 Key individuals on the team Name Role/position Relevant qualifications & past experience 1. 2. 3. 4. 5. 3.2 What level of expertise does your team have in project management, commercialisation and business management? Seed funding application form to the UCC Incubation Support Initiative 3.3 How shall the UCC funds applied for be utilised? Provide breakdown in terms of the activity, its total cost and the amount sought from UCC for the activity 3.4 Do you have any other funding available to implement the project? If yes, please elaborate. 3.5 Do you have an agreement with any incubator or submitted such application? Please elaborate