Partner Search Form

Date of submission: _____________

1. Company Details

1.1 Organization Name
Full Name
Parent Organization	(If any)
Type of Organization	(___________)

1.2 Organization Address
Street	nº
Complement	Zip Code
City - State	Country

1.3 Contact Person Data
Full Name
Position in Company
Phone Number	Mobile
E-mail

1.4. Website address

1.5 Organization Background
Year Established	Annual Turnover
No. of Employees	No. of R&D Personnel
General Information
Core Business & Area of Expertise	(Sector / Sub Sector or Expertise, Key Product Areas and Product Development Areas).
Main Products / Services
Comments	(If any).

2. The Proposed Project

2.1 Main Area of the proposed project
(__________)

2.2 Description of the proposed R&D project

3. Potential Czech / Israeli Partner

3.1 Expected main characteristics and specific technological expertise of the potential partner

3.2 Specific R&D contribution you are seeking from the partner
(________________________________________)

3.3 Comments (other specifications)

3.4 Wish-list of companies to contact in the Czech Republic / Israel
If applicable.

By returning this form you are authorizing CzechInvest / MATIMOP (respective implementing agency) to release the information supplied in the form to third parties in the process of identifying potential partners for the proposed project.