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Capita Scaling Partner Digital Disruptor Application Form

logoThank you for applying to become a Capita Scaling Partner Digital Disruptor. This initiative is the first in the TechMarketView Early Stage Partner Programme and is run in association with Capita Scaling Partner, Capita's new startup development business.

To apply to attend a Pre-Qualification Session, please complete this application form as fully as possible and submit it by Friday 13th April. We will advise you if your application has been successful by Friday 25th May. The Pre-Qualification Session will be logoheld on Wednesday 4th July 2018 at Capita's London headquarters

To be eligible, you should be the founder or CEO/MD of an early-stage UK tech company that has a digital technology proposition with the potential of disrupting established markets or creating new markets. By 'early stage' we mean a company whose product or service is (i) at – or close to – the MVP (minimum viable product) stage: (ii) has been successfully deployed to one or more clients; and (iii) is now looking to distribute at scale.

There is no fee required to apply for or participate in the Capita Scaling Partner Digital Disruptor Pre-Qualification Session.

You can find further information about the event on the TechMarketView website and about the Capita Scaling Partner programme on the Capita website.

For any further information please contact tmvesp@techmarketview.com.

 
COMPANY INFORMATION

Company name *
(As registered at Companies House)
 

Company Number *
(As registered at Companies House)
 

HQ address *
 

HQ phone number *
 

Website address *
 

Twitter handle
 

LinkedIn page
 

Facebook page
 

Year founded *
 

Company description *
(Brief description of your company's products/services.)
 

Primary revenue source *
(Select from the drop-down list the primary source of your company's revenues)
 

Primary revenue source (explanation)
(Please add any explanation if needed)
 

Number of employees *
(How many people currently work for your company and how many of them are freelance contractors? )
 

Company control *
(Which of the following options best describes ownership of you company?)
 

Company control (explanation)
(Please use this space to clarify your answer to the prior question if you need.)
 

Funding status *
(Please advise when you next expect to require funding and at what level.)
 

MARKET FOCUS

Sector focus *
(Please tick your focus sectors.)
 

Sector focus (explanation)
(Please add any further explanation of your previous answer if you need.)
 

Fastest growing sector *
(Which of these is your FASTEST GROWING sector?)
 

Geographical focus *
(Please tick your focus geographies)
 

Geographical focus (explanation)
(Please use this box if any further explanation is required)
 

Fastest growing geographical region *
(Which is your FASTEST GROWING geographical region?)
 

PARTNERSHIP POTENTIAL

Revenue run rate *
(What is your CURRENT annualised headline revenue run-rate?)
 

Projected annual revenues in 2020 *
(What is your forecast for your annual revenues in 2020?)
 

Projected EBITDA in 2020 *
(What is your forecast for your annual EBITDA in 2020?)
 

Largest client *
(Who is your largest client and what is the current revenue run rate you derive from them?)
 

Intellectual property *
(What proportion of your revenues do you consider to be attributable to your own intellectual property (IP). )
 

Obstacles to growth *
(What are the main obstacles to doubling your revenues in the next 12-24 months (please select up to THREE)? )
 

Other
(If Other, please explain)
 

Ambition *
(Why do you think Capita should partner with your company?)
 

RESPONDENT INFORMATION

First name *
 

Surname *
 

Position/Title *
(Please note that this application should only be completed by the company Founder or CEO/MD.)
 

Contact phone number *
 

Contact email address *
 

Source *
(How did you hear about the Capita Scaling Partner Digital Disruptor event?)
 

Source (Other)
(Please advise how you heard about the Capita Scaling Partner Digital Disruptor Event if not from one of the sources above.)
 

PLEASE PRESS GREEN 'SUBMIT FORM' BUTTON WHEN COMPLETE. If you do not see a confirmation screen, please scroll up and check that all mandatory fields have been completed and then press SUBMIT again.

The information in this form will be used by authorised TechMarketView and Capita personnel with a specific need to know to assist in the selection of applicants to participate in the Capita Scaling Partner Digital Disruptor Event. TechMarketView and Capita may also contact applicant companies to apprise them of their respective products and services. Information will not be passed to other third party organisations without permission from the applicant company.

 

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