Application Form

Part I - Project Details

Project Name

Area of Activity of Grupa Azoty

Part II - Participant’s Data

Name of the Entity Submitting the Project

Address of Registered Office

Website

Country of Origin

Contact Person

Telephone Number

E-Mail Address

Part III - Project Description

Description of the offered solution and its application (description of the solution, which need of Grupa Azoty or the market you want to solve, what is the area of its application, who is the target recipient of the solution)

Description of anticipated benefits due to implementation of the solution (what financial/non-financial benefits will the implementation of the solution bring to Grupa Azoty? If possible, please, provide an estimate of the size of these benefits, the method of their calculation, etc.)

Description of competitive solutions (please describe competitive/similar solutions functioning in the market)

Description of key competitive advantages (please indicate the competitive advantages of your solution)

Level of development of the solution (information on the status of the offered solution)

Assumptions for project implementation (description of activities required to be taken in order to implement the solution, description of milestones, list of owned resources, indication of necessary resources on the part of Grupa Azoty, etc.)

List of project deliverables

Implementation, testing, certification (please provide information confirming the indicated level of development of the solution - e.g. information about pilot/commercial implementations of the solution, information about held certificates, etc.)

Proposed model of cooperation with Grupa Azoty after completion of the pilot project, including settlement model (description of the assumed business model of cooperation with Grupa Azoty after completion of the project/pilot solution)

Part IV - Project Team

Please provide the names, surnames, experience and roles of any individual members of the project team in the project.

Part V - Material and Financial Schedule of the Project Execution

Fill in the document below and send it back to us.

Attach a schedule

Part VI - Information clause

I declare that I am familiar with the Regulations of the Idea4Azoty 2030 Programme, I accept its content and I undertake to comply with it.

I declare that I have been informed that:

Grupa Azoty S.A. with its registered seat in Tarnów, Poland, as the Organizer, is the Controller of personal data submitted in the Application Form for the purposes connected with the verification of fulfilment of formal conditions entitling to participate in the recruitment to the Programme.
The Grupa Azoty Group Companies participating in the Programme act as Independent Controllers in the recruitment process to the Idea4Azoty 2030 Programme;
Detailed information on the principles of personal data processing, including compliance with the information obligation referred to in Article 13 of the GDPR (General Data Protection Regulation), is contained in §8 of the Regulations of the Idea4Azoty 2030 Programme.

I give my consent to processing my data in the scope mentioned in the Application Form by the Organizer and other Companies of the Grupa Azoty Group participating in the Programme in order to recruit to the Idea4Azoty 2030 Programme.

I agree that the Organizer shall forward the Application Form to the Azoty Group Companies participating in the Programme in order to recruit me into the Idea4Azoty2030 Programme.

I also declare that:

The data contained in this Application Form are correct in law and in fact.
If the declarations referred to above prove to be incorrect in fact or in law, in the event of any claims by third parties, I shall be solely and entirely liable and declare that I shall bear all costs, in particular damages.