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Great British Scaleups: Pre-Qualification Form - GBS1

Thank you for your interest in the TechMarketView Great British Scaleup programme, in association with ScaleUp Group.

To qualify for participation in the TechMarketView Great British Scaleup programme, you must be a privately held, UK-owned tech SME with at least 20 employees. You should be able to demonstrate revenue growth of at least 20% p.a. with a minimum £3m annualised revenue run rate, and have clear potential to accelerate growth, especially in overseas markets.

In order for your company to be to be considered for particpation in the first event, to be held on 28-29 June 2017, please will you complete this Pre-Qualification Form (PQF) as fully as possible and submit it by Friday 5th May 2017. There is no fee required to apply for or participate in a Great British Scaleup Event.

We aim to notify all applicants on the status of their application by 26th May 2017. We may contact you prior if we need further clarification about your application.

If you have any further queries please contact gbs@techmarketview.com

 
COMPANY INFORMATION

Company name *
(As registered at Companies House)
 

HQ address *
 

HQ phone number *
 

Website *
 

Twitter handle
 

LinkedIn page
 

COMPANY OUTLINE

Year founded *
 

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

Market positioning *
(What is it that differentiates your products and services from your competitors'?)
 

Number of employees *
(Select from the drop-down list the number of full-time equivalents in your company )
 

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

Other
(If 'Other', please briefly explain)
 

Proprietary IP *
(What percentage of your company's primary revenue source derives from your proprietary intellectual property?)
 

Partner channels *
(What %age of your total revenues is derived through partner channels?)
 

Leading partners
(Who are your top three channel partners?)
 

COMPANY MARKETS

Operating geographies *
(Please tick all geographies in which your company currently has active operations such as sales offices, development labs, support centres, partners, etc )
 

Client geographies *
(Please tick all geographies from which you derive at least 10% of your total revenues.)
 

Growth market *
(Which of the above is your fastest growing market? At what rate is it growing?)
 

Client vertical sectors *
(Please tick all those vertical market sectors from which you generate at least 10% of your company's revenues.)
 

Other
(Please specify if you selected Other above)
 

Growth sector *
(Which of the above is your fastest growing vertical sector? At what rate is it growing?)
 

Client concentration *
(What percentage of your total revenues derives from your Top 5 clients?)
 

Reference clients *
(Give the names of three reference clients)
 

COMPANY LEADERSHIP

Key executives *
(List the company's key executives and their roles)
 

CEO tenure *
(For how many years has the current CEO been in this role?)
 

Founder involvement *
(Are any of the company's founders still involved with the business? If so, in what role(s)?)
 

COMPANY OWNERSHIP

Public/Private *
(Are any shares in your company listed on a public stock exchange (Yes/No)? If yes, please specify below.)
 

Public exchange
(If Yes, give name and country of the exchange on which your shares are listed)
 

Major shareholders *
(List those shareholders who own 5% or more of the company's equity and the percentage they hold)
 

COMPANY FINANCIALS

Most recent FY revenues *
(What were your headline revenues in your most recently recorded financial year?)
 

Headline revenue growth *
(What was the headline revenue growth in your most recently recorded financial year?)
 

CAGR *
(What was the compound annual growth rate (CAGR) of your headline revenues over the past three financial years?)
 

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

EBITDA *
(What was your EBITDA in your most recently reported financial year?)
 

Recurring revenues *
(What proportion of your revenues do you consider as 'recurring', i.e. under periodic payment (typically monthly or quarterly)for a pre-contracted duration?)
 

EBIT *
(What was your IFRS EBIT/operting profit in your most recently reported financial year?)
 

Pre-tax profit *
(What was your IFRS pre-tax profit in your most recently reported financial year?)
 

Net profit *
(What was your IFRS net profit in your most recently reported financial year?)
 

Net debt *
(What was the level of net debt on your most recently reported balance sheet?)
 

COMPANY OUTLOOK

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)
 

RESPONDENT INFORMATION

First name *
 

Surname *
 

Position/Title *
 

Contact phone number *
 

Contact email address *
 

Source *
(How did you hear about the TechMarketView Great British Scaleup Programme?)
 

Other source of infotmation
 

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 TechMarketView and official partners and sponsors to assist in the selection of applicants to participate in the Great British Scaleup programme. TechMarketView and official partners and sponsors 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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