Name *

First Name

Last Name

Is your company registered in the UK? *

Note: we limit the scope of the investments that we put to the group to UK registered and operated businesses,

Yes

No

Have you applied to us before? *

Yes

No

Have you previously raised more than £1m from external investors (excluding grant funding)? *

Yes

No

Please confirm that you are: Raising <£2m, a science and engineering based or tech enabled healthcare company, and not a consultancy or brick-and-mortar store *

Yes

No

Please confirm that you have read our investment criteria on our 'For Entrepreneurs' page: *