Application Form for Innovation Award of the Year 2015

NATIONAL RESEARCH DEVELOPMENT CORPORATION
(An Enterprise of DSIR, Ministry of Science & Technology, Govt. of India)
Anusandhan Vikas, 20-22, Zamroodpur Community Centre,
Kailash Colony Extension, New Delhi-110048, India
Tel - EPABX : +91-11-29240401 to 29240408, Direct :29240699
Fax : +91-11-29240409 to 10
Email: [email protected] or [email protected] Website: www.nrdcindia.com
APPLICATION FOR INNOVATION AWARD OF THE YEAR - 2015
PART-A

2. PARTICULARS OF THE APPLICANT (S): (Maximum Number of Applicants shall not exceed five)
i) Name of the principal innovator
Sr.No. Name Designation Name of the organization Academic qualifications Sharing % of award amount*
1.
ii) Name(s) of the co-innovator(s)
Sr.No. Name Designation Name of the organization Academic qualifications Sharing % of award amount*
2.
3.
4.
5.
*For unequal sharing of award amount, please indicate the percentage of the amount against the name of the applicants.

iii) Official & residential address
Sr.No. Official address Residential address Phone (with STD Code) Mobile E-mail
1.
2.
3.
4.
5.

3. DETAILS OF DEVELOPMENT:
(a) Stage (Tick any one, as applicable)
(b) Period

*Enclose List of Licensees, Their Production Capacity, Annual Sales (Exports and Domestic Market) and Employment Generation

4. DEVELOPMENT WORK CARRIED OUT AT: (Please give organization / Institute’s address)[Not exceeding 250 words]

5. DETAILED TECHNICAL DESCRIPTION OF INNOVATION (Give its constructional and working mechanism along with photographs, drawings, line diagrams, videos of the device/plant)[Not exceeding 3000 words]:

Upload File 1 (Valid file types: .pdf, .jpeg, .jpg, .gif or .png):

Upload File 2:

Upload File 3:

6. PRINCIPLE INVOLVED IN THE INNOVATION: [Not exceeding 1000 words]

7. ORIGINALITY/NOVELTY OF THE INNOVATION:[Not exceeding 1000 words]

8. ADVANTAGES/ IMPROVEMENTS OVER KNOWN ALTERNATIVES (Indigenous/ Imported) :[Not exceeding 1000 words]

9. TESTS CARRIED OUT: (Add test reports/ field trial reports/ user’s and/or demonstration certificates)

Upload File 1:

Upload File 2:

Upload File 3:

10. DETAILS OF OTHER AWARDS :
(a) Whether innovation has received any other award?
(if yes, give details )
(b) Have applicant’s applied earlier for NRDC award:
(if yes, give details )

11. DETAILS OF PATENT: (a) STATUS
(i) India
(i) Provisional/ Complete Specification (enclose copy of official filing receipt)
(if yes, give details )
(ii) Patent granted (enclose copy of patent document)
(if yes, give details )

(ii) Abroad
(i) PCT application filed (enclose copy of official filing receipt)
(if yes, give details )

(ii) Countries designated (enclose copy of requesting National phase application)
(if yes, give details )

(iii) Patent granted/Filed in specific country(ies) (enclose copy of patent document/official filing receipt)
(if yes, give details )

(b) GENERAL

Do patent include names other then those mentioned in item 2 above? (if yes, enclose NO OBJECTION CERTIFICATATE from those whose names are not included, indicating that they have no objection on your applying for this award)

(ii) If patent search has been conducted please enclose a copy of the report.
(if yes, give details )

12. DETAILS OF APPLICANTS’ EMPLOYMENT :
PART B
SUMMARY SHEET

Innovation Awards
1. TITLE OF THE INNOVATION:

2. PARTICULARS OF THE APPLICANT (S):
Sr.No. Name Academic qualification Designation
i
ii
iii
iv
v
4. STATUS OF PATENT(India) :
 (Abroad):

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