InterSystems UK Partner Pitch Event Application Form V1

Thank you for your interest in the InterSystems UK 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.

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

To apply, you need to be an established solutions provider to the financial services sector headquartered in the UK or the Republic of Ireland, ideally serving global markets. You could be an independent software vendor that sells applicaions or solutions to financial services organisations or a hybrid cloud preofessional and managed service organisition that delivers a solution to financial services customers.

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

Company name *

(As registered at Companies House)

Company Number *

(As registered at Companies House)

HQ city *

(In which city is your headquarters located?)

HQ phone number *

(Telephone number of your main office (including country code))

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)

Number of employees *

(How many people currently work for your company (Full Time Equivalents) )

Company ownership *

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

Company ownership (explanation)

(Please add any explanation if needed)

Funding status *

(Have you received any external funding other than from management, employees, family and friends and other 'insiders'?)

Solution maturity *

(Which of the following best describes the maturity of your solution)

Use of InterSystems products *

(Do you currently use InterSystems products as part of your solution? Please use the following question to explain further if needed)

Use of InterSystems products (explanation)

(Please add explanation if needed)

Intellectual property *

(What proportion of your revenues do you consider to be attributable to your own intellectual property (IP))

Sector focus *

(Which of the following sectors does your solution primarily play to? Please select all that apply and use the following question to explain 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 revenues *

(What proportion of your revenues derive from your leading market above?)

Anchor client *

(Who is your largest client? Would they be willing to be a reference if we need?)

USP *

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

Revenue run rate *

(What is your current annualised headline revenue run rate?)

Revenue growth *

(What is your forecast for your revenues in 2023?)

EBITDA *

(What is your current annualised EBITDA?)

EBITDA growth *

(What is your forecast for your EBITDA in 2023?)

Partnership option *

(Which of the following partnership options are you applying for? Please see our website for explanation)

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 InterSystems?)

Leverage *

(What is it you think that you and InterSystems could do better together than alone?)

Ambition *

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

RESPONDENT INFORMATION

Position/Title *

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

Contact email address *

Source *

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

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 InterSystems personnel and authorised partners with a specific need to know to assist in the selection of applicants to participate in the pitch sessions. Applicant information will not be passed to other third party organisations without permission from the applicant company.