GAPICT Entry Form - 2016

Note that fields marked with an asterisk (*) are required and the word limit for each field is indicated in brackets.

Contact Information
First Name*
Last Name*
Name of business (if registered)
Mobile number*
Alternative number
Email*
Primary operating address*
Address Line 1
Address Line 2
City or Town
Province
Postal Code
Innovation or Business Concept
Name of innovative concept or technology*
Describe your innovative concept or technology* (300)
What is the main problem or opportunity you are addressing?* (300)
What is your main technology field?*
☐Mobile application
☐Other software or web site/ application
☐Connectivity (e.g. fibre, wireless)
☐Sensing/ monitoring and control
☐Data analytics and modelling
☐Trust and security
☐Knowledge management and information systems
☐Content/ media development and localisation
☐Other
What is your main area of application?*
☐Mining
☐Manufacturing
☐Energy
☐Water
☐Transport and Logistics
☐Finance
☐Gaming/ Entertainment
☐Geo-Spatial Observation and Astronomy
☐Health
☐Education
☐Politics and Government Administration
☐Journalism
☐Community Safety
☐Other
Which option best describes your stage of development?*
☐Concept/ idea
☐Researching/ doing feasibility studies
☐Model or prototype developed
☐Pilot implementation in place
☐Started production/ implementing at a customer
☐Tweaking a successful product
Market Information and Impact
What are similar products or services and who are your main competitors?* (150)
Why is your approach different or unique and why is it better than other products or services?* (150)
Have you done any market research and who do you think will be the main users of your product or service?* (150)
How do you plan to support the idea financially or make money from this innovation?* (150)
What is the anticipated social impact from your innovation or business such as jobs created, increased competitiveness of local industry, healthier or more educated citizens, more effective or efficient service delivery by government?* (150)
Implementation Information
How far developed is your innovation, and how long before you expect to implement at your first customer?* (150)
Why are you entering this competition and how will winning seed funding and incubation benefit the development of your innovation or business?* (150)
What are your development support needs?*
☐Access to finance
☐Technical assistance (product or service development)
☐Access to market
☐Business advice
☐Intellectual property protection
☐Office facilities
☐Other
What education, work or business experience do you and any members of your team have?* (150)

I have read and accept the Rules of the GAP ICT innovation competition (tick for yes): ☐

Email this form and relevant attachments (incl. supporting diagrams or pictures up to 6MB filesize) to .