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Assuria Partner Pitch Event Application Form

Thank you for your interest in the Assuria Partner Pitch Event, held in association with the TechMarketView Innovation Partner Programme.

You can find further information about the qualification criteria along with FAQs and terms and conditions HERE. PLEASE TAKE THE TIME TO READ THIS INFORMATION BEFORE APPLYING.

In order to be considered you must complete this application form and submit it by 6pm Friday 12th March 2021.

Online pitch sessions will be held week begnning 12th April 2021.

After we review your application we may ask you to submit further information about your company to assist our evaluation.

We will advise you if your application has been successful by Friday 26th March 2021. 

To apply, you should already be providing cybersecurity solutions or IT services or communications services to your customers and have a reasonable knowledge and appreciation of cybersecurity risks. Most importantly, you need to have the desire, capability and resources to establish a new Managed Security Services Provider (MSSP) business within or alongside your current operations.

There is no fee required to apply for or participate in the pitch session.

The form should be completed by the Founder, CEO, MD or other board-level executive.

This form is most easily completed on a laptop or tablet though will also work with small form-factor devices. Please note that response boxes with a little triangle in the bottom right can be expanded to whatever size you need by clicking and dragging on the triangle. You can then insert multiple lines of text. Response boxes without a triangle are single line, for short amounts of text only.

We strongly suggest you print your completed form BEFORE you press the submit button using your browser's print facility so you have a record of your application.

YOU WILL RECEIVE A CONFIRMATION EMAIL IF THE FORM IS SUBMITTED SUCCESFULLY. IF YOU DO NOT RECEIVE AN EMAIL PLEASE NOTIFY amiller@techmarketview.com

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

For the purposes of GDPR, details of our privacy policy can be found here.

 
COMPANY OVERVIEW

Company name *
(Registered company name)
 

Company Number *
(Registered company number)
 

Trading name
(If different from Company name)
 

HQ city *
(In which city is your headquarters located?)
 

Year founded *
 

Number of employees *
(How many people currently work for your company (Full Time Equivalents) )
 

Company description *
(Brief description (couple of sentences) of your company's products/services. Please avoid boilerplate from your website. )
 

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)
 

Revenues *
(What are your current annualised revenues (select from the dropdown list))
 

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

Company ownership (explanation)
(Please add any explanation if needed)
 

SOLUTION OVERVIEW

Business solutions *
(Which of the following are provided by your business (select all that contribute more than 5% of your revenues))
 











Business solutions (explanation)
(Please add explanation if needed)
 

Cybersecurity experience *
(Which of the following best describes the level of knowledge, capability and experience of cybersecurity in your business? Please use the follow-on question if you need to explain further)
 

Cybersecurity (explanation)
(Please add explanation for the prior question if needed)
 

Cybersecurity exposure *
(What proportion of your revenues do you consider to be currently attributable to cybersecurity)
 

USP *
(What makes your business special - even unique? What is it that truly differentiates your business in the marketplace?)
 

CUSTOMERS AND MARKETS

Sector focus *
(Which of the following sectors does your business primarily play to? Please select all that apply and use the following question to explain if needed)
 














Sector focus (Explanation)
(Please add explanation if needed)
 

Customer locations *
(Where are your clients located? Please select all regions that generate at least 5% of your revenues)
 










Customer locations (explanation)
(Please add any explanation if needed)
 

Leading market *
(Which region generates the highest revenue for your business by location of customer? )
 

Leading market (explanation)
(Please explain if needed)
 

Reference clients *
(Please give the names of a couple of organisations who you consider as reference clients)
 

PARTNERSHIPS

Current partners
(Please name any partner organisation(s) that account for 10% or more of your current revenues.)
 

Partnership proposition *
(Why do you think you would make a great partner for Assuria?)
 

Ambition *
(How would you like your company to be viewed by the market in, say, five years' time?)
 

Obstacles to growth *
(What are the main obstacles to your company's growth? Please select up to three)
 














Other obstacles
(If Other, please explain)
 

RESPONDENT INFORMATION

First name *
 

Surname *
 

Position/Title *
(Please note that this application should only be completed by the company Founder, CEO/MD, or other board-level executive)
 

Respondent phone number *
 

Respondent email address *
 

Company website address *
 

Company LinkedIn page
 

Company Twitter handle
 

Source *
(How did you hear about the InterSystems Partner Pitch Event?)
 

Source (Other)
(Please explain if you replied 'Other')
 

PLEASE PRESS THE GREEN 'SUBMIT' 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 Assuria personnel and authorised partners with a specific need to know to assist in the evaluation of applicants as potential Assuria partners. Applicant information will not be passed to other third party organisations without permission from the applicant company.