ใบสมัคร Application form

1.0 Corporate Information

Company Name*

Date of Incorporation*

DD

MM

YYYY

Employee Size*

Legal structure of the company*

Private Limited
Public Listed
Government Owned/Linked

Primary Address*

Country

Phone Number*

Fax Number

Company Website

Business Size*

Kindly indicate your annual revenue range below

*Additional documents to corroborate the financial details above can be appended to this form.

2.1 Contact Person Information

Name*

Designation*

Mobile Number*

Email*

2.2 Secondary Contact Person Information

Name*

Designation*

Mobile Number*

Email*

3.0 Category

Category*

Product
Service & Solution
Organisation & Culture

4.0 Submission Summary

*

1. How long has the innovation been commercialized? Please tick.*

12 months
18 months
>24 months

2. What is the distinctiveness of the innovation?*

3. Has the innovation generated any returns on investment?*

4. How does the innovation generate societal impact and solve existing problems in our society?*

5. Why is the innovation sustainable and can it be replicated?*

6. How practical is the innovation and why is it viable?*

7. Is the innovation supported by any institution? If Yes, please explain:*

5.0 Supporting Documents

(LIST below the supporting documents and materials you are submitting to support the project or program, i.e. brochures, photos, press clippings, etc.)

Attachments

Drop files here or

InnoMark Fee (Thailand)

Total (inclusive of GST 7%)

$0.00

IMPORTANT! A non-refundable Certification Fee of USD1,605 (GST Included) is required with every application. This non-refundable. Certification Fee will cover administrative expenses and processing fee. The ONLY fee payable for submission is the Certification Fee (USD1,605). Resubmission of the same entry within one year for any failed certification application is allowed with zero cost. In the event of different submission entry within one year, an extra Certification Fee of USD803 (GST Included) is applicable. If you are approached by anyone to pay for any other fee on top of the stated Certification Fee ,please contact info@enterpriseasia.org immediately.

Payment

Credit Card

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

6.0 Declaration

*

I hereby declare that the information and supporting documents submitted herein am to my best of knowledge, true and verifiable. I understand and agree that should any of the information submitted herein and as supporting documentations are found to be factually incorrect or are designed to mislead the judges, my application will be null and void. I declare that I am not related to any staff of the Organizers or to any judges appointed by the Organizers (except normal business relationship, if any). I further declare that I have not attempted and will not attempt in any manner, monetary or otherwise, to influence the decisions of the Organizers and/or the judges.

I Agree

Name

This field is for validation purposes and should be left unchanged.

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