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Company Name

Address

Website

Contact Name

Contact Number

Contact Email

Brief description of product/service offered

Last Year’s Turnover

Jurisdictions where it was generated (%)

Please enter a 0/zero for any Jurisdictions where no revenue was generated.

United Kingdom %

Asia %

Australia %

Europe - Non EU %

USA %

ROW %

Europe %

Canada %

12 Month Revenue forecast

12 Month Revenue Forecast

United Kingdom %

Asia %

Australia %

Europe - Non EU %

USA %

ROW %

Europe %

Canada %

From Inception have you raised £5m or more in funding for the business? No Yes

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