I d e a m i n t

Registration Form

First Name:

Last Name:

Email:

Nationality :

Are you an Non Resident Indian ? Yes No

If 'Yes', Country of Residence :

Contact Information

Permanent Address:

City:

Zip Code:

Country:

Mailing Address: Use Permanent address as my mailing address

City:

Zip Code:

Country:

Daytime Phone Number:

Evening Phone Number:

Fax Number:

Personal Information

Date of birth:
Tax Payer ID:

Annual Income:

Liquid net worth:

Net worth (excluding home):

Occupation:

Industry:

Employment Information

Are you self employed ? Yes No

If 'Yes' Please complete the following details
Nature of Business :

Name of Company :

If 'No'
Employer Name :

Position Held :

Investing Experience

Have you had any experience with the Stock Market ? Yes No

Have you had any experience with Private Placements ? Yes No

If 'Yes', which companies have you private placed with ?

How would you like to be notified of new opportunities posted on the ideamint site?

E-Mail :

Fax :

Mail :

Investor Profile

This is the part of your application that an entrepreneur will have access to once you have expressed interest in the entrepreneur's company. Please do not include any information you wish to keep private

Areas of Interest and Expertise

E-Commerce

Communications, Networking & Internet

Hardware

Software

Information Services

Semiconductors

Medical Sciences

Consumer Products & Services

OTHER

Please describe any other areas of interest :

Are you actively involved in or have been actively involved in any companies?

Have you been actively involved in any emerging technology or startup companies ?

What is your preferred size of investment in a private company (select all that apply)?

Under Rs. 5,00,000 (< $12,500)

Between Rs. 5,00,000 to Rs. 50,00,000 ($12,500 to $125,000)

Rs. 50,00,000 to Rs. 1,00,00,000 ($125,000 to $250,000)

Greater than Rs. 1,00,00,000 (> $250,000)

Any additional information you would like to include in your profile ?

I agree to have read all of ideamint.com's legal notices and requirements and I agree to comply with them.