中韩合作项目英文申请表

China-Korea
Industrial Technology R&D Cooperation
Application Form
Submission Date:
Contact Person: (name) (tel) (cell) _____________
1. General Information
1.1 Project Title
(Do not exceed 120
characters)
1.2 Summary
(Do not exceed 240 characters)
1.3 Main Technological
Area
1.4
Organization
Name
Role of
Participant
Country Contribution
( %)
Budget
($US)
Duration
(months)
Total budget to the project : 1.5 Start Date
1.6 End Date
2. Project Outline
2.1 Description
(Approximately one A4 page)
2.2 Technological Development Envisaged (Level of innovation)
(Approximately one A4 page)
2.3 Market Potential and Commercialization Plan
2.4 Cooperation Between Participants (synergies, particular advantages, etc.)
2.5 Expected Outcome of Project
2.6 IP Ownership Arrangements
If there are additional "other Chinese participants", please copy the following page
3. Work plan Chinese Participant
3.1 Participant Contact Details:
3.1.1 Organization Name
Full Name
Parent Organization
Type of Organization
SME Large company Other 3.1.2 Organization Address
Street
Zip or Postal Code City
Country
Telephone Fax
3.1.3 Contact Person Data
Last Name First
Name
Function Title
Direct Telephone and
Mobile Phone
Fax
E-mail
3.1.
4. Website
3.1.5 Organization Background
Year Established
No. of Employees No. of R&D Personnel
Stage (Seed, Revenue, Pre-Clinical, Clinical) General Information
Core Business and
Area of Expertise
IP
Main Products/
Services
Markets and
Customers
Current year (i) i-1 i-2 Sales (for the Last 3
Years)
Comments
3.2 Work- Description and Contributions to the Project
3.3 Work Plan and Timeline
3.4 Budget and Resources
3.5 Other Sources of financial Support Related to Proposed Research Is this, or related
research/development,
presently being supported by
other sources?
If yes, indicate other sources,
amounts, and dates of
performing of the R&D under
this support
Has your company previously
received other sources of
governmental support ?
If yes, list up sources and dates
If there are additional "other Korean participants", please copy the following page
4. Work plan Korean Participant
4.1 Participant Contact Details:
4.1.1 Organization Name
Full Name
Parent Organization
Type of Organization
SME Large company Other 4.1.2 Organization Address
Street
Zip or Postal Code City
Country
Telephone Fax
4.1.3 Contact Person Data
Last Name First Name
Function Title Direct Telephone and
Mobile phone
Fax E-mail
4.1.4. Website
4.1.5 Organization Background
Year Established
No. of Employees No. of R&D Personnel
Stage (Seed, Revenue, Pre-Clinical, Clinical) General Information
Core Business and
Area of Expertise
IP
Main Products/
Services
Markets and
Customers
Current year (i) i-1 i-2 Sales (for the Last 3
Years)
Comments
4.2 Work- Description and Contributions to the Project
4.3 Work Plan and Timeline
4.4 Budget and Resources
4.5 Other Sources of financial Support Related to Proposed Research Is this, or related
research/development,
presently being supported by
other sources?
If yes, indicate other sources,
amounts, and dates of
performing of the R&D under
this support
Has your company previously
received other sources of
governmental support ?
If yes, list up sources and dates
The 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. In addition the participants have or intend to put in place, a formal collaboration agreement.
Signature of Chinese Participant
Organization Name
Full Name
Name of Person Signing
Last Name First
Name
Function in Organization
Signature
Signature of Korean Participant
Organization Name
Full Name
Name of Person Signing
Last Name First
Name
Function in Organization
Signature。