Your Name
Your Birthdate
Your Marriage Date
The organisation you represent
Do you own the organisation? YesNo
Your designation
Any alternate email ID
What customer pain point does your business address? (50 words)
Which of the following sectors do you think your business belongs to? (Please tick any number of boxes)
Which of the following geographies are you doing business in? (Please tick any number of boxes)
IndianChinaJapanRest of AsiaAustralia / New ZealandMiddle EastNorth AfricaRest of AfricaEastern EuropeWestern EuropeNorth AmericaSouth AmericaAll
At what stage is your business in? (Please tick any one)
Idea / Seed stageMinimum Viable Product is nearly readyBusiness Model appears to be getting validatedGrowth stagePre-IPOMature businesses Are you looking for funding? YesNo
Upto USD100,000 / INR 75 lakhHigher, but less than USD1mn / INR 7.5 croreSize is not a constraint
Please describe your last mobilization round
Funding came in ______ (year)
Funding came from Co-foundersFamily and friendsAngel investors / networkIncubater / AcceleratorGovernment sourcesPE/VC Fund Any other comments on your past mobilization (100 words)
What kind of support are you looking for? (Please tick any number of boxes) Mentor / CoachConsulting / AdvisorySome functions to be outsourcedAccess to inputs / resourcesAccess to marketsFundingAny other
Any other comments on your past mobilization (100 words)
Which social media channels do you access (Please tick any number of boxes) FacebookInstagramPinterestLinkedInYouTubeOther
Any other comments? (upto 100 words)
