PROPOSTA DI ATTIVAZIONE DI SPIN OFF DELL'UNIVERSITA' DELLA TUSCIA

Il / I seguente / i soggetto / i Proponente / i: 

- Prof. / Dott. ………………………. afferente  presso il Dip.di ……………………………………..

- Prof. / Dott. ………………………. afferente presso il Dip. di …………..………………………....

- Prof. / Dott. ………………………. afferente presso il Dip. di ……….…………………………….

- Prof. / Dott. ………………………. afferente presso il Dip. di…………..………………………….

CHIEDE / CHIEDONO

di poter attivare uno Spin-off dell'Università avente le seguenti caratteristiche:

1.  Nome della Società:

2.  Forma giuridica:

3.  Capitale sociale (sottoscritto/ da sottoscrivere):

4.  Oggetto sociale: 
(prodotti e/o servizi oggetto della nuova attività di impresa che costituiranno l’oggetto sociale dello spin off” la cui formulazione andrà riportata integralmente nello Statuto);

5.	Compagine sociale:

PERSONE FISICHE:
	Cognome	Nome	Qualifica	Quota di capitale sociale sottoscritta o da sottoscrivere	Percentuale rispetto al capitale sociale	
1.						
2.						
3.						
4.						
5.						
6.						
7.						
8.						

In aggiunta ai precedenti soci, il proponente richiede anche la partecipazione dell'Università della Tuscia e/o di altre persone giuridiche nei seguenti termini: 

PERSONE GIURIDICHE:
	ENTI PUBBLICI	SEDE	Quota di capitale sociale sottoscritta o da sottoscrivere	Percentuale rispetto al capitale sociale	
1.	Università della Tuscia				
2.					
3.					
4.					

ENTI PRIVATI:
		SEDE	Quota di capitale sociale sottoscritta/da sottoscrivere	Percentuale rispetto al capitale sociale	
1.					
2.					
3.					
4.					

6.  Breve descrizione delle attività professionali, scientifiche e "curricula" dei soci proponenti (anche in allegato)

7.  Locali presso i quali la Società intende stabilirsi:
(se si tratta di locali dell'Ateneo, allegare la delibera del Consiglio di Dipartimento che ha espresso parere favorevole alla concessione in uso dei locali individuati e ha determinato il relativo corrispettivo)

LOCALI	C/O
Dipartimento, Centro, Facoltà , ecc	Durata	Uso esclusivo/promiscuo	Corrispettivo annuo	

					

Locali non di proprietà dell'Ateneo:

SEDE o
UNITA’ OPERATIVA	VIA	CITTA'	CAP	

				

8.	Descrizione del progetto imprenditoriale.

Per lo sviluppo del progetto imprenditoriale si propone la seguente griglia:

A)	Prodotti e/o servizi oggetto della nuova attività di impresa.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B)	Indicazione sui mercati/clienti di riferimento (ad esempio dimensioni mercato, segmenti target, tassi di sviluppo, concorrenti, canali distributivi, politiche di prezzo, ecc.).
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C)	Elementi distintivi rispetto ai prodotti/servizi già disponibili e ai concorrenti attuali e potenziali.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________

D)	Obiettivi a regime (mercati serviti, gamma di prodotti/servizi, quote di mercato, fatturato, ecc.).
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

E)	Fasi e tempi per l’avvio/sviluppo dell’idea imprenditoriale, obiettivi intermedi.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

F)	Elementi di criticità (tecnica, economico-finanziaria, partner, competitiva, risorse, ecc.)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________

9. Aspetti tecnologici caratterizzanti

Griglia proposta:

A)	Ricerca da cui è scaturito il prodotto/progetto impresa con indicazione specifica se tale ricerca sia stata condotta nell’ambito di un contratto di prestazioni conto terzi o se sia stata finanziata da soggetti esterni..
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B)	Tecnologie di prodotto.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C)	Tecnologie di processo.
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D)	Disponibilità di brevetti propri o altrui e di altre competenze tecnologiche uniche.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

E)	Collegamenti con l’attività istituzionale dell’Università della Tuscia.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________

10. Risorse umane e ripartizione di funzioni e responsabilità.
Griglia proposta:

A)	Tipologia di competenze necessarie.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B) Ruoli chiave dal punto di vista tecnico e gestionale.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C) Modalità di reperimento delle competenze e di copertura dei ruoli chiave.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D) Ruolo dei soci nell’organizzazione.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

E) Indicazione degli Amministratori della compagine sociale.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11. Obiettivi economici (primi tre anni)

		Conto Economico	
		Anno 1	Anno 2	Anno 3	
Ricavi (specificare per tipologia di prodotto/servizio)					
Ricavi (specificare per tipologia di prodotto/servizio)					
Ricavi (specificare per tipologia di prodotto/servizio)					
Totale Ricavi					
Costi industriali 					
Costi commerciali					
Costi amministrativi e generali 					
Altri costi					
Reddito operativo					
Oneri Finanziari					
Altri proventi/oneri (specificare)					
Imposte 					
Utile netto					

12. Prospetto degli Investimenti (primi tre anni)

Natura dell’investimento	Valore	Anno di realizzazione	Modalità di finanziamento	

				

13. Prospetto dei Finanziamenti e contributi (oltre le quote di capitale iniziale sottoscritte dai soci) (primi tre anni)

Soggetto finanziatore	Natura del soggetto finanziatore 	Importo	Natura del finanziamento	Anno	Note 	

						

14. Altre informazioni ritenute rilevanti ai fini della valutazione dell’iniziativa imprenditoriale 
Eventuali ulteriori informazioni che il proponente ha ritenuto non coerenti con i punti precedenti, ma ritenute rilevanti al fine della comprensione e valutazione dell’iniziativa imprenditoriale proposta.

Viterbo, li						Firma del proponente