Appendix 1 – Tender Form

to the Procedure for the submission and selection of investment proposals for the establishment of corporate venture capital funds under the BRIdge VC Programme financed through the PFR NCBR CVC FIZ and Private Investors’ funds

  1. Type of Tenderer

Fund Manager
Existing capital fund
  1. TENDERER’ DETAILS

Tenderer (full name/corporate name or first name and surname)[1]
Tenderer’s address:
Number of entry in the National Court Register (KRS)[2] for the Tenderer (complete if applicable):
The Tenderer’s personal identification number PESEL[3](complete if applicable):
Person responsible for contacts with the Call Organiser:
Electronic mail (email) address and telephone number of the person responsible for contacts with the Call Organiser:
Contact details for correspondence related to this Call:
1)electronic mail (email) address:
or
2)fax number:
Correspondence address (if different than the Tenderer’s address stated above):

Appendix to the Tender Form:

1)Verification Form for the Tenderer’s Team Members,

2A) Details of the Private Investor other than a natural person[4],

2B) Statement by a Private Investor being a natural person,

3)The Tenderer’s Statement,

4)Investment Strategy,

5)Certificate of clean criminal record[5],

5A) Declaration of no criminal record and no criminal proceedings pending,

6)Financial statements of the Fund Manager/capital fund for the last financial year[6].

The Tenderer hereby declares that it consents to the processing of its personal data contained in the present Form for the purpose of Tender assessment, in accordance with the Act of 29 August 1997 on personal data protection (Journal of Laws of 2016, item 922) and to the disclosure thereof by the Call Organiser solely to institutions offering financing from public funds (PARP, NCBiR, BGK, ARP), and to entities forming part of the corporate group of which the Call Organiser is a member, and also to the competent ministry in charge of the management of the SG OP (managing authority) for the verification of the experience mentioned in Appendix 1 to the Tender (Verification Form for the Tenderer’s Team Members) to the extent necessary for the evaluation of the Tender and to ensure the correct implementation of the financial instrument.

SIGNATURES:

______
First name and surname of Tenderer/ First name and surname of person authorised to represent the Tenderer[7]
______
Date, place

1 of 2

[1]Where the Tenderer is a group of natural persons, please enter the first names and surnames of all the natural persons.

[2]or its equivalent for a Tenderer with a registered office outside Poland.

[3]or its equivalent for a Tenderer who is not a Polish national..

[4] For item 2B– attach is applicable.

[5] For items 5 and 5A – attach if applicable.

[6] For item 6 – attach if applicable. Not applicable if the Tenderer is a group of natural persons.

[7] Where the Tenderer is a group of natural persons, the Tender should be signed by all persons forming the Team; otherwise, the Tenderer should demonstrate the representation right (authority) of the persons signing the Tender and attach to the Tender Form an exceprt from the relevant register, a power of attorney or other corporate documents confirming the authority to represent the Tenderer.