World’s Leading
Innovation Certification
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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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone Number
*
Fax Number
Company Website
Business Size
*
Kindly indicate your annual revenue range below
USD 1 Million to USD 5 Million
USD 5 Million to USD 10 Million
USD 10 Million to USD 15 Million
USD 15 Million to USD 20 Million
USD 20 Million and above
*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. Name of Innovation
*
2. How long has the innovation been commercialized? Please tick.
*
12 months
18 months
>24 months
3. What is the distinctiveness of the innovation?
*
4. Has the innovation generated any returns on investment?
*
5. How does the innovation generate societal impact and solve existing problems in our society?
*
6. Why is the innovation sustainable and can it be replicated?
*
7. How practical is the innovation and why is it viable?
*
8. 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
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
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
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 Organisers or to any judges appointed by the Organisers (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 Organisers and/or the judges.
I Agree
Comments
This field is for validation purposes and should be left unchanged.
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