Higher Education Commission
Best Innovator Award 2017
Please fill out the form and attach necessary documents to this application.
Add lines as needed.
I. Personal Information
1. Name: / 2. Nationality
3. Gender:
c Male c Female / 4. Place of Birth:
5. Date of Birth (dd/mm/Year): / 6. Age:
7. NIC # / 8. Present Position:
9. Postal Address: / 10. Name of Current Institution and Address:
11. Contacts: a) Phone / b) Cell: / c) E-mail:
II. Professional Details
1. Research Domain
1.c Natural Sciences
2.c Biological Sciences
3.c Agricultural Sciences
4.c Health Sciences
5.c Pure Engineering
6.c Computer Science/Engineering
7.c Social Sciences
8.c Management Sciences
9.c Arts/Humanities/Languages
2. Field of Research and Specialization [For example; (Major: Chemistry, Specialization: Organic); (Major: Economics, Specialization: Development Economics); (Major: Energy, Specialization: Solar) etc.]
Major ______
Specialization ______
III. Academic Qualification:
Degree Held: / Year Awarded / Field of Study: / Institution:
V. Resume
Please attach a 2 page resume highlighting your accomplishments
VI. Patent Information:
Please attach patent award/issuance certificate
Patent Title:
Patent No:
Year of grant:
Name of country/countries where patent has been filed/granted:
VII. Invention Category:
□ Design □ Device □ Method □ Product □ Other
Name of Institution/s where the idea was conceived:
VIII. Description of Invention:
Please provide brief description of the Invention
IX. Applications of Invention:
What are the immediate and/or future applications of the invention?
X. Novelty and Usefulness:
What are its novel and unusual features? What problems does it solve? What are the advantages that your invention provides other than available solutions?
XI. Reduction to Practice:
Is work on the invention continuing? Are there limitations to be overcome or other tasks to be done prior to practical application? Is there any test data? Have products, apparatus or compositions, etc., actually been made and tested?
XII. Commercial Partners:
Has the technology been licensed to anyone….. Yes: □ No: □
Names and addresses (if known) of potential commercial partners:
:
XIII. Competitors:
Companies presently offering comparable technology (if known):
Company Name Brand name Product
XIV. Profitability:
Has the innovation been commercialized? ….. Yes: □ No: □
If yes, has any profit been earned? Yes: □ No: □
If yes, please provide data on gross and net yearly profits:
If no, please indicate projected profits based on market research
XV. Development/Further Research:
What further research and development is necessary or desirable before showing the invention for a potential industrial license?
XVI. Inventor Information:
Please list names of all the inventors/assignee institutions.
1) Name Position
Department
Business Address
Business Phone Business Fax
Email Address
Home Address
Citizenship NIC#
2) Name Position
Department
Business Address
Business Phone Business Fax
Email Address
Home Address
Citizenship NIC #
3) Name Position
Department
Business Address
Business Phone Business Fax
Email Address
Home Address
Citizenship NIC #
By signing below and submitting this Application Form, I------agree that the information I have provided above is accurate to the best of my knowledge.
Signature / Initial: / Date:

Please send three (3) sets of complete application forms to the following address;

(Only hard copies are admissible)


CONTACT:

Ms. Noshaba Awais

Director (R&D)

Higher Education Commission

H-9, Islamabad

Page 3 of 4