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["国家小型微型企业创业创新示范基地"]
["申请报告"]
[]
[" "]
[" "]
[" "]
[" "]
["      申请单位名称：                                    （盖章）"]
["                   "]
["      填报日期：               年          月         日"]
[]
[]
["工 业 和 信 息 化 部 制"]

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["申请报告主要内容"]
["一、国家小型微型企业创业创新示范基地申请表(附表1）"]
["二、管理和服务人员名单及职称情况一览表（附表2）"]
["三、服务的中小企业名单及服务评价表(80家以上)(附表3)"]
["四、基地申请相关情况说明（请另附说明材料）"]
["    （一）申请单位的基本情况（包括：创立发展沿革、"]
["发展目标、目前的基本情况）；"]
["    （二）基地内中小企业发展情况和服务需求情况；"]
["    （三）基地管理运营情况（包括：主要管理制度、人"]
["员激励、能力提升、品牌建设、可持续发展等）；"]
["    （四）近年来的服务情况（包括：主要服务内容、服"]
["务对象、规模以及服务收费情况，是否为小微企业提供公"]
["益性或低收费服务）；"]
["    （五）基地服务特色（包括：具有示范性的特色服务）"]
["    （六）主要服务业绩及基地内中小企业健康发展的贡"]
["献（包括：服务效果自测情况或典型案例）；"]
["    （七）下一步发展设想。"]

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[" ","附表1"]
["国家小型微型企业创业创新示范基地申请表"]
["申请单位（公章）：",{"$nulls":5},"单位：万元、人、平方米、家"]
["基本情况","单位名称",null,null,null,"基地名称"]
[null,"注册资本",null,null,null,"法人代表(负责人)"]
[null,"成立时间",null,null,null,"省级基地认定时间",{"$nulls":7}," "]
[null,"网  址",{"$nulls":4},"主管部门\n（指导部门）"]
[null,"联系人",null,null,null,"联系电话"]
[null,"创业基地面积","规划面积",{"$nulls":4},"建筑面积"]
[null,null,"自 有",null,null,"租 用",null,null,"公共服务场所"]
[null,"申报单位从业人员数量\n（截至2015年12月31日）"]
[null,"服务人员",null," ",null,null,"创业辅导师\n（省级中小企业主管部门认定或持证）"]
[null,"引入外部专业服务机构数量",{"$nulls":4},"入驻企业数量"]
["运营情况","基地为入驻企业提供办公、生产、服务场所（列举）"]
[null,"基地信息化基础设施",null,"光纤接入情况",null,"宽带带宽",null,null,"无线信号覆盖情况"]
[null,"经营情况","年 份","资产\n总额","营业\n收入","入驻企业数","其中：小微企业数",null,"小微企业占入驻企业比例",null,null,"基地内企业从业人数"]
[]
[]
[]
[null,"是否具备基地发展规划（具体材料请以附件形式提供）",null,null,null,"基地年度发展目标（可另附说明材料）"]
[null,"是否具备基地管理规章制度（具体材料请以附件形式提供）",null,null,null,"基地服务项目收费标准（可另附说明材料）"]
["合作服务\n机构情况","合作服务机构名称",null,null,"主要服务内容",null,null,null,"签订协议时间"]
[]
[]
[]
[]
[]
["服务功能情况","主要服务内容",null,null,"服务规模",null,null,null,"服务收入占年营业收入比例"]
[]
[]
[]
[null,"是否为入驻入驻企业提供信息服务及简况"]
[null,"是否为企业提供创业辅导及简况"]
[null,"是否为入驻企业提供创新支持及支持简况"]
[null,"是否为入驻企业提供人员培训及培训简况"]
[null,"是否组织市场营销活动及活动简况"]
[null,"是否为入驻企业提供投融资服务"]
[null,"是否为入驻企业提供管理咨询服务及服务简况"]
[null,"基地为入驻企业给提供的其他专业服务情况"]
["示范性自述\n（不超过400字）"]
{"$rows_empty":22}
["注：1.具体服务机构及服务内容可自行添加行\n"]
["2 .国家小型微型企业创业创新示范基地申请示范点自述应当参照《国家小型微型企业创业创新示范基地建设管理办法》中申报的示范条件进行列举"]

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[null,"附表2"]
["管理和服务人员名单及职称情况一览表"]
["序号","姓名","性别","年龄","学历","职务","职称","主要工作内容"]
{"$rows_empty":19}
["注：含创业辅导师"]

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[" ","附表3"]
["国家小型微型企业创业创新示范基地入驻企业评价表"]
["序号","企 业 名 称","法人代表","入驻时间","从业\n人数","联系电话","接受服务内容","服务评价"]
[{"$nulls":7},"很满意","基本满意","不满意"]

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