邢唷> 欹 鳵 bjbj磜趠趠a eeeD)=| i!=#(e#e#e#&_&_&_)h+h+h+h+h+h+h$攌6nNOhue&_坁^鎊@&_&_Ohe#e##;膆癬癬癬&_.le#ee#筬p癬&_)h癬癬)b9,Qbe#饘烪綶T_.Ab趆0 iIb刵俖.刵Qb刵eQbT&_&_癬&_&_&_&_&_OhOh癬&_&_&_ i&_&_&_&_刵&_&_&_&_&_&_&_&_&_  :  Instructions: Both partners applying for the programme should fill this form in together and submit it to Israel Innovation Authority (IIA) and Science and Technology Commission of Shanghai Municipality(STCSM). 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70勑$If^0`勑 7$Ifrkd淜$$If40婟%R&0n(44 Fa旋f4h%j%l%n%&{i 7刪剺$If^刪`剺 7$If 7tkdZL$$If4斚 0婟%R&0n(44 Fa旋f4n%%%& &P&R&V&&&&&&&&&缪楷楷晙l]MA.MA%j翸h?OJPJQJU^Jh?OJPJQJ^Jjh?OJPJQJU^Jh?CJOJQJ]乛JaJ&h?CJOJPJQJ^JaJmH sH )h?5丆JOJPJQJ^JaJmH sH -h?CJOJQJ^JaJmH nHo(sH tH%h?CJOJQJ^JaJnHo(tH"h?CJOJQJ^JaJmH sH +h?56丆JOJQJ]乛JaJmH sH /h?56丆JOJPJQJ]乛JaJmH sH &&&&'X''oggg$If勷$IfWD^勷` 7$IftkdM$$If4擧0婟%v%0n(44 Fa旋f4&&&&&&'''''4'6'8':'P'V'X'Z'v'x'z'|''''''''''''燔汤濎芴缞汤濎芴纖汤濎h汤U汤焯%j哖h?OJPJQJU^Jh?CJOJQJ]乛JaJ%j鶱h?OJPJQJU^J%j扤h?OJPJQJU^Jh?CJOJPJQJ^JaJ%j*Nh?OJPJQJU^Jh?OJPJQJ^Jjh?OJPJQJU^Jh?OJPJQJ^JnHtH&h?CJOJPJQJ^JaJnHtH!''''(ND4.$If勷$IfWD^勷` 7$IfkdbO$$IfT4謗婟~ z%v~ ~ ~ ~ 0n(44 Fa旋f4奣 Life Science u}T褃f[ FORMCHECKBOX  Agriculture 淨N FORMCHECKBOX  Others vQ僛Technology Subsector P[啒遅3.2 Work  Description and Contributions to the Project (Wy橆v-Nb舃剉錧\O蔛鵞y橆v剉!.s  3.3 Work Plan and Timeline 錧\OR孴鰁魰h 3.4 Budget and Resources剺梴孴蟸9峞g恘 Other Sources of Financial Support Related to Proposed ResearchN遙xvzy橆v鴙sQ剉vQ僛蟸9峞g恘 3.5.1 Is this, or related R&D, presently being supported by other sources? If yes, indicate other sources, amounts, and dates of performing the R&D under this support鍕y橆vb鴙sQ剉x裇顅MR/f&T gvQ僛蟸9/ec俌 g 鲖衏汷蟸9峞g恘0pe顅孴蟸90RMO_薡x裇剉鰁魰0  3.5.2 Has your company previously received other sources of governmental support? If yes, list up sources and dates.ON錘MR/f&T梍0R菑?e淾D崺R俌 g 鲖R鶴y橆v蟸9 T饄孴諷梍鰁魰0 4. Project Participants  Partner 2y橆v耂NUSMO T\O筫2 (錘rR筫3uON) 4.1. Participant Profile 耂NUSMO酧o`4.1.1 General Profile 鶺,g酧o`Full Name of CompanylQ鳶hQ饄Registration # 鑜孮鱏Prior name of Company lQ鳶(u T Company Stage裇U\6柕k FORMCHECKBOX Seed 蛓P[g FORMCHECKBOX R&D x裇g FORMCHECKBOX Initial Revenues R薡6eeQg FORMCHECKBOX Revenue Growth 6eeQ瀀gYear Establishedb藌t^齆No. Employees 菛XT篘peNo. R&D Personnel x裇篘XT篘pe4.1.2 Company Contact InfoT鹼酧o`Street Address 0W@WCity蜽^Country齎禰Telephone5u輯 Fax Ow WebsiteQ賨 E-mail5uP[異鯪4.1.3 Contact PersonT鹼篘First Name TLast Name覻TitleLMOFunctionL#Phone5u輯Mobile PhoneKb:gEmail5uP[異鯪4.1.4 Organization Background lQ鳶虁ofGeneral Business Description & Area of Expertise N俰饛NNN啒遅 Technology Description (Main Products/Services)b/g蟘饛;N亯罷/ g  Targeted Customers 顅h7b IP鍂茓Cg臽礠 Sales (for last 3 years)褟3t^.UN閪Current year (i),gt^ i-1 籗t^i-2 MRt^Comments vQ僛魦f 4.1.5 Technology Sector & Subsector of Company (Select 1 or 2 sectors and specify 1 or 2 corresponding subsectors )lQ鳶剉b/g啒遅錘蔛P[啒遅  愰bN*Nb$N*N啒遅 v^kX橯N*Nb$N*NwQSOP[啒遅  FORMCHECKBOX  ICT酧o`愥O FORMCHECKBOX  Energy 齹恘 FORMCHECKBOX  Environment 痵僗 FORMCHECKBOX  Materials Pg檈 FORMCHECKBOX  Manufacturing 6R  FORMCHECKBOX  Life Science u}T褃f[ FORMCHECKBOX  Agriculture 淨N FORMCHECKBOX  Others vQ僛Technology Subsector P[啒遅4.2 Work  Description and Contributions to the Project (Wy橆v-Nb舃剉錧\O蔛鵞y橆v剉!.s  4.3 Work Plan and Timeline 錧\OR孴鰁魰h 4.4 Budget and Resources剺梴孴蟸9峞g恘 4.5 Other Sources of Financial Support Related to Proposed ResearchN遙xvzy橆v鴙sQ剉vQ僛蟸9峞g恘 4.5.1 Is this, or related R&D, presently being supported by other sources? If yes, indicate other sources, amounts, and dates of performing the R&D under this support鍕y橆vb鴙sQ剉x裇顅MR/f&T gvQ僛蟸9/ec俌 g 鲖衏汷蟸9峞g恘0pe顅孴蟸90RMO_薡x裇剉鰁魰0  4.5.2 Has your company previously received other sources of governmental support? If yes, list up sources and dates.ON錘MR/f&T梍0R菑?e淾D崺R俌 g 鲖R鶴y橆v蟸9 T饄孴諷梍鰁魰0 5. Statement of Cooperation T\O餢fThe participants signing this form intend to co-operate within the project as described in this form with the aim realizing the technical developments as set forth under point 2. 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