GCIP Pre-Accelerator Application Form - Technology Innovation Agency

March 10, 2025
Uncategorized

First Name *

Last Name *

Title (at Company) *

Company *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country *

Nationality *

Please provide your South African ID *

Gender *

Disability *

Ethnicity *

Ethnicity (Other) *

What is your age range? *

Province *

Did you find this programme through one of the GCIP Implementing Partners? *

Other

Email Address *

Email Address (Second Optional)

Contact Phone *

LinkedIn URL

Website

Year Founded *

Please indicate which SDGs that your company impacts upon. For more information on the SDGs, see here: https://sdgs.un.org/goals *

Sustainable Development Goals0 / 250

Business Stage

Current annual revenue

FINANCIAL DOCUMENTS

Please upload your financial documents:

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1. Signed off latest Annual financial statements

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2. 3 and 12 Monthly management accounts (Balance Sheet, Income Statement, Cash Flow Statements)

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3. Bank statements for the last three months

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4. Profit and loss of the last three months

Problem *0 / 300

Please provide a description of your company, and its products or services *0 / 300

Commercial Viability or Potential Scalability *0 / 300

Please share any sales collateral, a company profile or business plan?

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Company registration docs and valid tax certificate

Company ownership - South African citizen *

What percentage of your company is black-owned?

Company ownership - gender *

MANAGEMENT TEAM

Upload file *

Please upload the curriculum vitae or biographies of the management team

Permanent or Full-time Founder/CEO *

Permanent employees *

Part time employees *

Current growth strategy *0 / 300

Funding sought *0 / 300

Your Partners *0 / 300

Previous funding *Please use the following template to list all previous funding you have received: Investor: (Name) Amount: (Include the Currency) Year: Financial Instrument: (i.e. Debt, Equity, or Grant)0 / 300

Social and/environmental Impact *0 / 300

Previous accelerators/incubators or pitching competitions *0 / 300

Office Address

Phone Number

Email Address

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