SAFE STEPS D-Tech Awards 2021 Application Form

A Few Notes Before You Begin
- There are 12 sections to this form. You are able to save your application progress and return at a later date.
- Please keep your responses within the indicated limit.
- Please do not submit any confidential or proprietary information through this application.
- Applications must be in English to be considered.
- The deadline for sending applications is 11:59 p.m. (HK/SG time zone, GMT +8) on 19 February 2021. We encourage you to apply early so that we may reach out to you for any clarifications if required.
- Please review the SAFE STEPS D-Tech Awards Frequently Asked Questions and AVPN’s Data Protection Policy before proceeding.
- If you have any questions, please write to dtech@avpn.asia

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Basic Information
In this section, please provide the following details about your organisation.
Registered Name of Organisation*
Description of Organisation*
Organisation Website*
Is your organisation a non-profit or a for-profit entity?*
You will be asked to upload relevant registration documents in the later sections of this application form.
- Non-profit
- For-profit
Where is your organisation headquartered?*
If a local office is applying, please indicate the location of the local office.
Name of Organisation Representative*
The representative of the organisation will be the person taking part in other phases of the competition, should your organisation be selected.
Designation of Representative*
Email Address of Representative*

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Market Size
In this section, we’d like to learn more about the disaster-related challenges and markets you are addressing.
What is the disaster-related challenge that your technology solution is addressing? How big is this problem in Asia-Pacific?*
Please use metrics where possible, e.g. number of people affected and how this affects their lives.
What is the present and potential market size of this problem? What is driving this growth? What is your market share today and your target for the future?*
This question is mandatory for for-profits and optional for non-profits. Please mark N.A. if you are a non-profit who would not like to answer this question.

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Problem-Solution Fit
In this section, we'd like you to expand on your Disaster Technology solution and how it seeks to address your identified challenge.
What is your technology solution? How does it help address the problem you described?*
What differentiates your technology solution? How is your technology solution unique/better compared to what already exists?*
What is the stage of development of your technology solution?*
Please note that we only accept applications from pilot stage and beyond.
- Pilot
- Production/Commercial Contracts

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Social Impact
In this section, please describe the social impact that your solution sets out to achieve.
What impact does your organisation have and what has been achieved to date?*
Please use qualitative and quantitative measures to describe your impact. If your organisation has not achieved impact yet, please indicate projected impact over the next 12-18 months.
How will the prize money affect the impact and sustainability that you can achieve?*

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Business Model & Traction to Date
In this section, we’d like to understand your business model, progress to date and future plans.
Please describe your business model.*
What markets/countries are your technology solution active in?*
Do you have any pilot or commercial agreements signed?*
If applicable, please also briefly share the results of pilots.
Please briefly outline how scalable your technology solution is, across different geographic and/or market segments.*
If applicable, please list any significant business partners (e.g. NGOs, governments, distributors, etc) and explain the nature of the partnership. Please exclude investors/funders.
If applicable, please list significant patents and intellectual property.
Please indicate if you have plans to sell your patent/technology in the next 3 years.
What are the key milestones (financial/non-financial) for your organisation / the technology solution over the next 3 years?*
If the technology solution is not already deployed in Asia Pacific, are there any plans to do so? If yes, please elaborate on the countries you have identified and your entry plans.*
What are the 1-2 significant risks for your organisation and this technology? How does the team plan to address them?*

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Financial Feasibility
In this section, please provide details on your organisation’s financial feasibility and sustainability plans.
Financial Details
Please provide high level financial details of your organisation from 2018-2020 in US dollars. If an answer is not applicable (e.g. if your organisation has been around for less than 3 years), please enter “n/a”.
Please also project expected revenues and expenses for 2021-2023; estimates are acceptable. Do not include potential funding from this competition.
Annual Operating Expenses*
Annual Business Revenue*
Prize Money/Grants Received*
2019 Annual Operating Expenses*
2019 Annual Business Revenue*
2019 Amount of Prize Money/Philanthropic Grants Received*
2020 Annual Operating Expenses*
2020 Annual Business Revenue*
2020 Amount of Prize Money/Philanthropic Grants Received*
2021 Annual Operating Expenses*
2021 Annual Business Revenue*
2021 Amount of Prize Money/Philanthropic Grants Received*
2022 Annual Operating Expenses*
2022 Annual Business Revenue*
2022 Amount of Prize Money/Philanthropic Grants Received*
2023 Annual Operating Expenses*
2023 Annual Business Revenue*
2023 Amount of Prize Money/Philanthropic Grants Received*
If you have received prize money / philanthropic grants, please indicate details.
e.g. source of funding, recurring/one off, etc.
Investment
If applicable, please provide details of your 5 most recent investors. If there are more than 5 investors in your most recent funding round, please list the 5 biggest investors of the most recent round.
Year
Details
Amount (USD)
Valuation (USD)
Year
Details of Investment
Amount (USD)
Valuation (USD)
Year
Details of Investment
Amount (USD)
Valuation (USD)
Year
Details of Investment
Amount (USD)
Valuation (USD)
Year
Details of Investment
Amount (USD)
Valuation (USD)

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Team, Board and Advisors
In this section, we'd like to know more about your team, board members and advisors.
Founding Team
Please provide the names, designation, bio and LinkedIn profiles of the top five core members of your founding team.
Full Name*
Designation*
Short Biography*
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Board Members

If applicable, please list the name, designation, bio and LinkedIn profiles of up to five board members.
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Advisors

If applicable, please list the name, designation, bio and LinkedIn profiles of up to five advisors.
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile
Full Name
Designation
Short Biography
LinkedIn Profile

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What else should we know?
Please include any other information you think we should be aware of in reviewing your application.

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Materials to be Uploaded
Presentation Slides*
You may share with us a presentation deck of no more than 10 pages (excluding cover and back page) that supports your responses above. Please include details on your solution, business model, and financials (historic and projected).
Accepted File Types: pdf, docx.
Accepted file types: pdf, docx.
Legal Registration Documents*
Please upload a copy of your organization's legal registration documents for confirmation.
Accepted File Types: pdf, docx., jpg, jpeg, png
Accepted file types: jpg, jpeg, png, pdf, docx.
Video Presentation
- We’d love to hear your story. In no more than 90 seconds please tell us:
  - • Who you are
  - • What motivated you to create your D-Tech solution
  - • Why you should win this competition
- The video should be in English and no more than 90 seconds.
- The person who will represent your organisation at future stages of the D-Tech Awards should speak in the video.
- Please record horizontally/landscape. You can record on a mobile phone.
- Feel free to present in a casual, Youtuber-style format.
- Please consider lighting and audio quality when recording.
- Please upload the video to Youtube, hashtag #SAFESTEPS #DisasterTech #DTech and provide the link in the box below.

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Additional Details
How did you find out about the SAFE STEPS D-Tech Awards?*
- AVPN
- e27
- International Federation of Red Cross and Red Crescent Societies (IFRC)
- National Geographic
- Prudential / Prudence Foundation
- Antler
- Hatcher+
- CSR Asia
- Other
If you indicated 'Other', please specify the organisation.*

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Declarations
Conflict of Interest Declaration
- By checking this box, I confirm that:
My team members and I have no conflicts of interest with AVPN or Prudence Foundation which could affect the objectivity in evaluating your application. (Note: A conflict of interest is considered to arise where a judge of the Awards or his/her family member, relative or close personal friend has or may have a vested interest (personal and/or business) which could reasonably be seen as having inappropriate influence over the judging or decision making of the Awards or any Award entrants or applications.)
If you are unable to confirm, please provide details here.
Data Privacy Declaration*
- By checking this box, I confirm that:
I/We have read and understood AVPN’s Data Protection Policy and obtained necessary consent or authorization for disclosing the submissions to the competition (including but not limited to representative’s name, designation, contact information) to Prudence Foundation and other partners of the SAFE STEPS D-Tech Awards.
Data Privacy Declaration
- By checking this box, I confirm that:
I/We give consent or have obtained necessary consent or authorization to AVPN, Prudence Foundation and other partners of the SAFE STEPS D-Tech Awards that my organisational and personal data (including but not limited to the representatives’ name, designation, contact information), trademark and materials submitted in this competition application can be used for marketing and publicity purposes and for making introductions to relevant stakeholders to increase the flow of financial, human and intellectual capital towards my organisation. If you would like to withdraw you consent, please contact our AVPN Data Protection Officer at technology@avpn.asia, and Prudence Foundation at prudence.foundation@prudential.com.hk
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SAFE STEPS D-Tech Awards 2021 Application Form

Step 1 of 12

A Few Notes Before You Begin

Basic Information

Market Size

Problem-Solution Fit

Social Impact

Business Model & Traction to Date

Financial Feasibility

Financial Details

Investment

Team, Board and Advisors

Founding Team

Board Members

Advisors

What else should we know?

Materials to be Uploaded

Additional Details

Declarations