Section A.

General Information
Name of the Company:
Date of establishment:
Name of Contact Person:
Email Address of Contact Person:
Country:
Austria Greece Portugal
Belgium Hungary Romania
Bulgaria reland !lo"a#ia
Cyprus taly !lo"enia
C$ech Republic %at"ia !pain
Denmar# %ithuania !&eden
Estonia %u'embourg (nited )ingdom
*inland +alta ,ther European not the European
(nion -specify.
*rance Netherlands ,ther -specify.:
Germany Poland
1. Please indicate whether you have been or are a partner in a project
consortium of please identify the project!:
*P/:
f you ha"e participated in *P/ #indly indicate the funding scheme under &hich you ha"e
recei"ed funding:
*P0:
f you ha"e participated in *P0 #indly indicate the funding scheme under &hich you ha"e
recei"ed funding:
,ther EC
fund:

f you ha"e participated in other EC funding opportunities1 #indly indicate the
programme2source of funding:
1a. "hat is the status of the project#
(nder E"aluation
,ngoing
*inished
Section $: Activities
%. Please select in which sub&sectors! your company was wor'in( in the last
three years. Please specify if you are very active in the sub&se(ment or not:
1 3 not acti"e4 % ) "ery fe& acti"ities* + 3 moderately acti"e* , 3 acti"e4 - ) "ery acti"e
Sub&sectors 1 % + , - not applicable
Digital content and Digital libraries: production1 management1
information processing

%o& le"el programming: programming languages1 operating
system1 programming interfaces

High le"el programming: global user interface1 configuration

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system1 security solutions
+odel tools1 compiler1 closs2compiler1 debugger1 simulation

ntegrated de"elopment en"ironment

Net&or# and telecom infrastructure
Net&or# and telecom ser"ices
!ecurity infrastructure

Components and de"ices -fi'ed de"ices.: Electronics1 DE+1
,D+1 Automation.

!mart de"ices -mobile.
Robotics
Application ntegrator: Rich application1 5eb application1
+obile application

6alue7Added Resellers and Dealers 8 +ass distribution
-on2off line channels.

+ass Distribution -offline2online.
!upport organi$ations: Business 8 consulting
,ther -please specify.:
+. Please state the final application.domain.mar'et your company was
focusin( durin( the last three years. /ou can choose more than one mar'et.
1 3 not acti"e4 % ) "ery fe& acti"ities* + 3 moderately acti"e* , 3 acti"e4 - ) "ery acti"e
Sector focus of investments 1 % + , - Not applicable
-including: telecommunications4 electronics and
microelectronics4 information systems and processing4
robotics4 automation4 net&or# technologies4 soft&are4
digital media and ser"ice applications.

Creati"e ndustries -including fashion4 design4
performing arts4 film4 tele"ision4 games and multimedia4
publishing4 architecture4 ad"ertising -excluding,
telecoms and mobile.

Biotech and %ife sciences
Health Care
Energy2En"ironment and Cleantech
Retail and Distribution
*inance and Business !er"ices -including Generic
Customised Company Performance solutions -ERP1
CR+1 etc..

%ogistics and transport
+anufacturing
,ther -please specify.
,. "hat has been the outcome in terms of commercial opportunity resultin(
from your 012 activity implemented under the 3C funded project or outside
the project#:
Ne& P

A prototype
A ne& process
A business plan
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A mar#et "alidation
Ne& product or ser"ice

,ther: 99999999999
None

f none1 do you ha"e any

acti"ity2product2ser"ice at this stage that has
commerciali$ation potential: ;;;;;;;;;;;;;
-. "hat do you need in order to commerciali4e your results#
Ne't stage in R8D Patent registration
Real conditions tests Creating production capacities
6alidations acti"ities E'tension of production capacities
Demonstration acti"ities Production
+ar#et "alidation +ar#eting
Business modelling Access to in"estors
,ther< Please specify:9999999999999999999999999999
Section C: Investments
5a< Are you loo'in( for e6ternal finance for the needs e6pressed above#
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5b. If yes9 what sources of e6ternal financin( have you approached or
interested in approachin(# Please tic' as relevant.
Interested in
Approachin(
Already approached
but unsuccessful
Already approached and
successful
Ban#
nstitutional in"estor
Corporate in"estor
Business Angels
6enture Capital
Public funds
,ther -please specify.
None
Don=t #no&
5c. Please indicate the amount of investment that you re:uire: ;<<<<<<<.
=. Please indicate what the fundin( would be used for:
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<..
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>. In your opinion9 what are the challen(es that your company is facin( in
accessin( e6ternal finance# Please specify on a scale from 1 to - where 1 is
not relevant and - crucial!
Challen(e 1 % + , -
%ac# of information about e'ternal finance
Amount of funds needed
%ac# of #no&ledge about financing
*e& opportunities for net&or#ing
,&nership of P
%ac# of e'perienced2s#illed management
team to ta#e the business for&ard

!calability of the business model 7 including in an
international conte't

E'it potential
>rac# record
,ther1 please specify:
999999999999999999<

?. "hat are your current sources of information re(ardin( access to e6ternal
finance#
nternet
Registration to regular information ser"ices -hardcopy or electronic.
Professional e"ents -conferences1 fairs1 &or#shops.
Pri"ate Bro#ers and other financial intermediaries
Chambers of commerce1 professional intermediaries
,ther< Please specify:9999999999999999999999999
Section 2: Services
1@. "ould you be interested in receivin( information about accessin( e6ternal
finance#
/3S 78
11b If your answer is /3S9 please indicate in which activity.service would you
be interested:
,nline information about access to finance in the sector
E7training on ?n"estment readiness=
Community of entrepreneurs and in"estors
+entoring by an e'pert in in"estment -personal contact.
,nline coaching by in"estment e'perts
5or#shops for in"estment readiness gi"en by in"estment e'perts
n"estment forum to pitch in"estors
Bro#erage e"ents bringing together !+Es and in"estors
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,ther< Please specify:999999999999999999999999999
1%. "hat other assistance would you consider useful for your company to
facilitate access to investment opportunities#
9999999999999999999999999999999999999<<
>han# you for your feedbac#@
,ur proAects are intended to assist !+Es in accessing "enture capital and in commercialising
their products2ser"ices< During the coming months &e &ill be creating tools that &ill assist
you< 5ith your permission &e &ill register the data pro"ided in a database and &e &ould li#e
to send additional information on our proAects as &e proceed< )indly tic# &here rele"ant@
am interested in being registered in the database of !+Es
am interested in recei"ing information on the proAect acti"ities trough the mailing list<
am interested in being contacted for further discussions on my feedbac#<
am not interested in being registered in the database of !+Es
am not interested in recei"ing information on the proAect acti"ities trough the mailing list<
am not interested in being contacted for further discussions on my feedbac#<
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