Request form

1. Contact Info

Name of the Innovator

Name of Company

Email ID

Contact number

2. MedTech Innovation Information

Name of the Technology

Intended Use Statement

Summary of the Technology

3. Please specify the nature of Assistance/Support required

I hereby give my permission to mPRAGATI to share personal information with relevant stakeholders associated with mPRAGATI and understand that mPRAGATI may hold information gathered about me through the portal and as such my rights under The Digital Personal Data Protection Act, 2023 will not be affected.

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