I．Applicant Information

Name of Applicant*

E-mail*

(Please re-enter for confirmation)

II．Applicant Profile

（In case proposed by a joint venture/multiple people, please enter information on a prime organization/person. Information on another organization/people needs to be described in the column of “Implementation Scheme” below.）

Phone Number*

Name of Organization （Please fill in the official name of the organization）*

URL of the Website*

Date of Establishment*

-- Janualy February March April May June July August September October November December

Number of Employees*

Ⅲ．Proposal

Reason for Application*

Please describe i) the outline of product/technology you are applying for, ii) how the product/technology contributes to solving the problems, and iii) competitive advantages of product/technology. （around 500~600 characters）

the outline of product/technology （around 200 characters）*

how it contributes to solve problems？（around 200 characters）*

the characteristic of product/technology, superiority against competitors（around 200 characters）*

Please indicate the stage of development/business on your products/technologies.*

The element technology has been proven, but not proven specifically for the theme of proposal. It is under conceptual phase.
It is in the conceptual stage and the elemental technology has been proven, but the prototype has not been developed.
The prototype has been developed, but there is no sales record
Initial products have been sold (there is sales record for Early Adopters)
The production and shipping has already begun, and its sales volume/stock are increasing
Products generate sustainable cash flow Other

Please describe experiences in sales/introduction of products/technologies both at domestic and international markets. If there is none of that case, please write none.*

Please describe the expected cost to introduce the product/technology to expand business in the target country after the PoC.*

Please explain objectives that you would like to demonstrate in PoC (purpose of PoC), validation items (please describe quantitatively including key performance indicators), the period required for PoC, and the implementation scheme.

purpose of PoC and validation items*

the period of PoC*

implementation scheme*

Please provide or attach the profiles of the representatives and the key members for PoC. (Biography, expertise, award history etc.)*

Approximate estimate costs for PoC (with breakdown)*

Please refer to the examples and fill in the cost estimation as much as you can.
The final amount will be decided in consultation with JICA after selection.
 
【Examples】
Total 〇〇yen（breakdown shown in below）
- Personnel expenses: 〇〇yen
- Material cost: 〇〇yen（test equipment:〇〇）
- Development cost: 〇〇yen
- Travel expenses: 〇〇yen（name of country, 〇times ×〇persons）

Please attach supplementary documents of products/technologies

max 3mb

Please explain a plan for post-PoC and its perspective*

Please describe if there is anything of note, for example expected issues and concerns. (up to 500 characters)

Please describe requests or expectations to JICA for PoC, if any

How did you know this project?

E-mail from the secretariat
MorningPitch e-mail newsletter
NineSigma
JGoodTech
SNS such as Facebook
Internet search
Other