Application Form for “MASERATI LIVE INNOVATION”
International Start-up event for Innovation

 

Max cumulative File Size 36 MB

1 Company data

1.1 Business Name

1.2 Address

1.3 Telephone number

1.4 E-mail address

1.5 Number of employees

1.6 Company registration list

1.7 Company website URL

1.8 Venture Capitalist / Angel list URL (Optional)

2 Company Legal Responsible data

2.1 Title

2.2 Full Name (name, surname)

2.3 Gender

2.4 Company position

2.5 Telephone number

2.6 Mobile phone number

2.7 E-mail address

3 Tell us about yourselves…

3.1 Company background (e.g. founding date, mission, co-founders background and expertise, startup financing cycle, business model, company roadmap - max. 20 lines)

3.2 Company structure (max. 20 lines)

3.3 Company organogram Insert an image in one of these formats: jpeg, png, tiff, bmp (max filesize: 8M)

3.4 URL of the web page to watch the company presentation video (Optional)

3.5 Company founding date

3.5.1 Compliance with the definition of "Innovative start-up" (Only for Italian Start-up)


3.6 Motivation to attend the “Maserati Live Innovation” event (max. 20 lines)

4 Tell us about your technology…

4.1 Explanation of company technology (max. 20 lines)

4.2 Industrial field (write a X in the corresponding box)

4.3 Rendering of the product / Workflow of the technology, algorithm Insert an image in one of these formats: jpeg, png, tiff, bmp (max filesize: 8M)

4.4 Examples of developed applications (max. 20 lines)

4.5 URL to see a demonstration video of the technology (Optional - max. 20 lines)

4.6 Technology Key Performance Indices (max. 20 lines)

4.7 Technology Readiness Level Mark the correspondent box in the third row.

TRL 1 2 3 4 5 6 7 8 9
Category Concept Idea Concept Design Concept Assembly Proof of Concept Concept Validation Alpha Prototype Beta Prototype Pre-profuction Prototype System Validation
Mark

4.8 H2020 Automotive Homologation Intelligence (Optional - max. 20 lines)

4.9 Intellectual property (max. 20 lines)

4.10 Proposal of innovative application of proprietary technology to the automotive industry (max. 20 lines)

5 Comments

6 Personal data processing

Mr./Mrs. , as legal representative of the company , authorize the use of company data for the activities specified at chapter 5 in “Call for Maserati Live Innovation”.

Signature of company legal representative


All employees of the start-up have to sign the following paper to authorize the use of their personal data for the activities specified at chapter 5 in “Call for Maserati Live Innovation”.

Signatures of company employees


7 Discharge of Responsibility

The company represented by Mr./Mrs. discharges Maserati SpA, UNIMORE and the Modena City council from any civil and penal responsibility in case of an accident and/or injury which may occur during the event and during transportation to the Marzaglia track. It is hereby claimed that the promoters of the event Maserati SpA, UNIMORE, Modena city council decline any responsibility for the information specified by the companies in the application form. The participation to the event does not legitimize a start-up to advertise itself as partner of any of the event promoter or use the names of the promoters to advertise its technology or activity. An admitted start-up may only advertise its participation to the “Maserati Live Innovation” event.

Signature of company legal representative


Date, place


Company stamp Insert an image in one of these formats: jpeg, png, tiff, bmp (max filesize: 8M)