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["附件3"]
["2021年中关村前沿技术企业发展需求表"]
["（ 2021 年 XX 月 XX 日）   "]
["企业名称："]
["金融服务类","□1.股权融资","本轮拟融资额：","目前估值："]
[null,null,"历史融资金额与领投机构："]
[null,null,"其他："]
[null,"□2.债权融资","□信用贷款     □担保贷款      □融资租赁    □其他"]
[null,null,"融资额：","借款年限："]
[null,"□3.改制上市","□境内上市（请填写上市板块）：      "]
[null,null,"□境外上市（请填写上市板块）：  "]
[null,null,"□新三板    □四板   "]
[null,"□4.其他","□企业兼并、合并、收购"]
[null,null,"具体需求："]
["产业对接类","□1.与央企及市属国企对接 ","□2.与京津冀对接         ","□3.与产业技术联盟对接        ","□4.产业链上下游企业对接"]
[null,"□5.与上市公司对接","□6.与在京重点实验室对接"]
[null,"具体需求："]
["人才服务类","            □企业人才培训  ",null,"□智库专家支持"]
[null,"具体需求："]
["用地类",null,"意向区域","面积","意向价格"]
[null,"□1.办公场所需求          "]
[null,"□2.其他用地需求"]
[null,"具体需求   ："]
["市场拓展类","□1.申报和推广中关村新技术新产品 □2.开展应用示范   □3.支持首台（套）重大技术装备试验       "]
[null,"具体需求："]
["国际化类","□1.拓展国际市场         ","□2.国际研发合作与交流   ","□3.出口信用担保","□4.了解国际贸易法规"]
[null,"□5.对接法律机构"]
[null,"具体需求："]
["品牌宣传类","□1.媒体宣传       □2.中关村展示中心展示     □3.参加展会       "]
[null,"具体需求："]
["政策类","目前政策障碍及具体需求：\n"]
["其他","具体需求："]