Fundraising questionnaire Thanks for your time: this will take 10 minutes 1. Please tell a little about yourself and your business.Name(Required) First Surname Email(Required) PhoneWebsite / URL Country(Required)AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsWhat is your role in the business?(Required) Founder/Joint founder C-Suite Member of management team Employee 2. Company profile: tell us a little more about your company.Company Name(Required) Company Trading Name(Required) Website(Required) Year founded(Required)Employee Headcount(Required) Country of incorporation(Required)AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 3. Management Please tell us about key people in your leadership team: we require at least one person please.(1) Name(Required) Title(Required) LinkedIn URL(Required) Experience level(Required)First time member of managementSome previous management experienceSeasoned management experienceSeasoned management experience, previous notable exitSeasoned management experience, >2 previous notable exits(2) Name Title LinkedIn URL Experience levelFirst time member of managementSome previous management experienceSeasoned management experienceSeasoned management experience, previous notable exitSeasoned management experience, >2 previous notable exits(3) Name Title LinkedIn URL Experience levelFirst time member of managementSome previous management experienceSeasoned management experienceSeasoned management experience, previous notable exitSeasoned management experience, >2 previous notable exits 4. Advisory board or existing investors If you have one, please tell us about key members of your official advisory board or existing investors(1) Name LinkedIn URL (2) Name LinkedIn URL (3) Name LinkedIn URL 5. Technology and commercial statusWhat primary technology best categorises your business?(Required)3D Bio-printingAgetechBiomarkersAI for drug discoveryAI for other longevity applicationsClinical services for longevityCyberneticsNutraceuticalsDigital healthGene therapyImmunotherapyNanotechnologyNeural integrationOrgan growthSenolytic drug therapyXenotransplantationOtherOther (please specify) What best describes your company's commercial status?(Required)We're a university spinout with unique intellectual property (pre-patent)We're pre-revenueWe're early revenueWe're scaling-up revenueWe're looking to acquireOther (please specify) 6. Product and developmentFlagship product or solution name(Required) Brief description(Required)Target(s) hallmark of aging (if you have defined) Altered intracellular communication Cellular Senescence Deregulated nutrient-sensing Epigenetic alterations Genomic instability Loss of proteostasis Mitochondrial dysfunction Stem cell exhaustion Telomere attrition (Recovery rate) Target disease/medical condition (if you have defined) Product commercial stage(Required)ResearchDevelopmentClinical trialsCommercialMarket approvedEarly commercialGrowth commercialPatent/IP(Required)We have unique IP (pre-patent)We have a patent application submittedWe have granted patent(s)We have a black box product/IPNot relevant to our businessWhat age-related diseases/indications could benefit from this product? Altered intracellular communication Alzheimer’s Disease Arthritis Cancer Cardiovascular Disease Cataracts Cerebrovascular Disease Cognitive aging Dementia Depression Diabetes Hearing loss Hypertension Hearing loss Mobility Osteoarthritis Osteoporosis Obesity Parkinson’s Other (please specify) Has your product undergone clinical trials?(Required)Yes - If yes answer next questionsNo, but we are planning to startNo, we have no plans for clinical trialsClinical trial stage of productEarly discoveryPre-clinicalPhase IPhase IIPhase IIIWere the population in your clinical trials healthy or did they have a current condition?HealthyCurrent condition – please specify belowAre you planning to advance the product to (possibly further) clinical trials?YesNoUndecidedOther (please specify) 7. Funding stageWhat funding stage is your company currently at?(Required)Grant funded but looking to raise equity investmentPre-seed investmentCurrently seeking seed investmentSeed-funded, pre-series ACurrently raising series ASeries A funded, pre-series BCurrently raising series BSeries B funded, pre-series CCurrently raising series CMezzanine funded ahead of potential IPOCash positive: don't need to fundraiseOther (please specify) 8. Target fundraiseWhat is your target investment for your next investment round?(Required)Below $0.5m$0.5m to $1m$1m to $5m$5m to $10m$10m to $30m$30m to $50m$50m+Current Pre-money valuation if known: What is your total funding to date?(Required) What share class are you offering?(Required)Same class as founders (voting)Non-voting sharesOtherWhen are you looking to close your round?(Required)Now6 months1 year2 yearsCommitted investors for current round (if you have any) Company name or investor name Company name or investor name Company name or investor name What do you plan on doing with this raised capital?(Required)ResearchDevelopmentClinical trialsSales and marketing scale-upRegulatory approvalAcquire IP or another companyOther 9. FinancialCurrent turnover / revenue?(Required) What is your projected growth in revenues in next 12 months?(Required)0%5-10%11-30%31-50%51-70%71-100%When do you see any potential for exit (mergers/acquisitions/IPO) ?(Required)1-3 years3-5 years5-10 years10+N/AWhat is your go to market entry strategy?(Required)Direct salesIndirect salesLicensingFranchisingPartneringOther (please specify) 10. Investor deckChoose fileAccepted file types: pdf, doc, docx, pptx, Max. file size: 20 MB.
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