Blockchain Innovation Initiative (BII) - Call For Proposals Registration Form


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Blockchain Innovation Initiative (BII) - Call For Proposals Registration Form
Please note that some of this information will be used as baseline data to monitor progress and measure impact over time for the projects selected. The data will also be analysed to assess the supply of and demand for blockchain technology in the region.

Best of luck!

1. CONTACT INFORMATION
2. NAME OF PERSON SUBMITTING THE APPLICATION *
3. COMPANY NAME *
4. EMAIL ADDRESS OF LEAD ENTITY *
5. CONTACT - PHONE NUMBER *
6. Categories Targeted For This Project                        (Select all that apply) *
Required
7. SOLUTION PROVIDERS
8. NAME OF ENTITY (Lead Entity Submitting the Proposal) *
9. TYPE OF BUSINESS *
10. YEAR OF REGISTRATION *
11. COUNTRY OF REGISTRATION *
Required
12. COUNTRY OF OPERATION (Select all that apply) *
Required
13. % OF WOMEN OWNERSHIP IN THE BUSINESS *
14. # OF FEMALE EMPLOYEES *
15. # OF MALE EMPLOYEES *
16. TOTAL NUMBER OF EMPLOYEES *
17. Gross revenues in USD$ generated in 2019 *
Required
18. NAME OF ENTITY (Company/ Partner 1)
19. TYPE OF BUSINESS
Clear selection
20. YEAR OF REGISTRATION
21. COUNTRY OF REGISTRATION
22. COUNTRY OF OPERATION (Select all that apply)
23. # OF FEMALE EMPLOYEES
24. # OF MALE EMPLOYEES
25. % OF WOMEN OWNERSHIP IN THE BUSINESS
26. TOTAL NUMBER OF EMPLOYEES
27. Gross revenues in USD$ generated in 2019
28. NAME OF ENTITY (Company/ Partner 2)
29. TYPE OF BUSINESS
Clear selection
30. YEAR OF REGISTRATION
31. COUNTRY OF REGISTRATION
32. COUNTRY OF OPERATION (Select all that apply)
33. # OF FEMALE EMPLOYEES
34. # OF MALE EMPLOYEES
35. % OF WOMEN OWNERSHIP IN THE BUSINESS
36. TOTAL NUMBER OF EMPLOYEES
37. Gross revenues in USD$ generated in 2019
38. NAME OF ENTITY (Company/ Partner 3)
39. TYPE OF BUSINESS
Clear selection
40. YEAR OF REGISTRATION
41. COUNTRY OF REGISTRATION
42. COUNTRY OF OPERATION (Select all that apply)
43. # OF FEMALE EMPLOYEES
44. # OF MALE EMPLOYEES
45. % WOMEN OWNERSHIP IN THE BUSINESS
46. TOTAL NUMBER OF EMPLOYEES
47. Gross revenues in USD$ generated in 2019
Entity in the Caribbean that is committed to explore the blockchain solution proposed for solving its problem
48. NAME OF ENTITY *
49. TYPE OF BUSINESS *
50. YEAR OF REGISTRATION *
51. COUNTRY OF REGISTRATION *
Required
52. COUNTRY OF OPERATION *
Required
53. % OF WOMEN OWNERSHIP IN THE BUSINESS (Private Sector Businesses ONLY)
54. # OF FEMALE EMPLOYEES  (Best Estimate)
55. # OF MALE EMPLOYEES (Best Estmate)
56. TOTAL NUMBER OF EMPLOYEES *
57. Gross revenues in USD$ generated in 2019 (PRIVATE COMPANIES ONLY)
58. NAME OF ENTITY (OTHER ENTITIES BENEFITING FROM SOLUTION)
59. TYPE OF BUSINESS
Clear selection
60. YEAR OF REGISTRATION
61. COUNTRY OF REGISTRATION
62. COUNTRY OF OPERATIONS
63. % OF WOMEN OWNERSHIP IN THE BUSINESS
64. # OF FEMALE EMPLOYEES
65. # OF MALE EMPLOYEES
66. TOTAL NUMBER OF EMPLOYEES
67.  Gross revenues in USD$ generated in 2019 (PRIVATE COMPANIES ONLY)
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