ANNEX I

Contracting Authority: CSIR/SANBio

BioFISA II Programme

Open Innovation Challenge

Reference:

Deadline for submission of Expression of Interest

3 March 2017

Title of the Project: / The title must not exceed 15 words and should capture the essence of the project in a concise manner
Location(s) of the Project: / Specify country(ies), region(s), area(s) or town(s) that will benefit from the project
Name of the lead applicant (institution or organization):
Country of the lead applicant:
Name of the co-applicant (institution or organization):
Country of the co-applicant:
Telephone number: (fixed and/ mobile) Country code + city code + number
Contact person for this project:
Contact person’s email:
Application No
(for official use only)

Any change in the addresses, phone numbers or email must be notified in writing to the Contracting Authority. The Contracting Authority will not be held responsible in the event that it cannot contact an applicant.

Summary of the Project

Please complete the table below.

Title of the project: / <The title must not exceed 15 words and should capture the essence of the project in a concise manner
Total duration of the project (months): / <Maximum 12 months>
Objectives of the project / Maximum 50 words>

Experience of the applicant

Please complete the table below which should not exceed 0.5 pages.

Introduction and background of participants: / < Provide a brief introduction of the Lead and Co-applicant and explain the nature of their operations>
Experience of the partnership or individual parties in line with the stated objectives of this project: / < Provide a brief summary of similar experience of the Lead and Co-applicant>

Project details

Please complete the table below which should not exceed 4 pages.

Project introduction: / Briefly describe and explain the key features and main concept/rationale of the project and current status. Include a brief outline of prior research and development.
Solution proposed / Clearly define the solution proposed to address the challenge defined, including any regulatory approvals that may be needed before the product is commercialised
Planned activities and targeted outputs: / List the main activities needed to produce the project outputs and main outcomes. Check that the activities are practical, realistic, feasible and coherent.
Team composition[1]:
Lead innovator with proven track record – please write a short CV
Other relevant experts with proven track record – please write a short CV

Only a short summary CV of any additional team members must be included.

Any change in the team composition must be notified in writing to the Contracting Authority and the proposed replacement should have equal qualifications and experience. The Contracting Authority will not be held responsible in the event that it cannot contact an applicant.

High level proposed budget

Deliverables / Cost
Deliverable 1 / (R)
Deliverable 2 / (R)
Deliverable 3 / (R)
Deliverable 4 / (R)
Total project cost (amount) / (R)

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Open Innovation Challenge application form

[1]Additional points will be given for the female candidates in the team