Declaration of Partnership

Declaration of Partnership

DECLARATION OF PARTNERSHIP

  1. Identification data of the person submitting the declaration (SUBMITTER)

Is thesUBMITTER a natural person conducting business activity? / Yes
No
Legal person’s or other entity’s business name/
Natural person’s name and surname
Legal person’s or other entity’s KRS number/
Natural person’s PESEL number
Taxpayer ID Number NIP
Business ID Number REGON
Registered office address/
Address of the place of business conducted by a natural person / Country
Voivodeship
Town/City
Postal code
Street
Building number
Flat number
Mailing address (if different from the registered office address / address of the place of business) / Country
Voivodeship
Town/City
Postal code
Street
Building number
Flat number
SUBMITTER’s website address
SUBMITTER’s e-mail address
  1. Data of the person empowered by the SUBMITTER to formal contacts with e-Chamber (CONTACT PERSON)

Name and surname
E-mail address
Telephone number
  1. Annexes

  1. Power of attorney (annex mandatory if the SUBMITTER is represented by an attorney)
/ 
  1. Identification of content-related groups (optional annex)
/ 
  1. Data to determine the annual salary (mandatoryannex)
/ 
  1. Declaration

1)The natural persons conducting business activity

By submitting this DECLARATION I am willing to establish cooperation with the Chamber of Digital Economy based in Warsaw, and I declare that I fulfil the conditions pursuant to Art. 1 para5 of the Statute / Art. 1 para6 of the Statute[1]and undertake to comply with the Chamber’s Statute,resolutions of the Chamber’s organs, the Code of Ethics, as well as to provide support for the Chamber in pursuing its statutory objectives in accordance with the Statute and the concluded partnership agreement.

2)Legal persons and other entities

Acting on behalf of the SUBMITTER, being authorised to represent him/her, I declare that by submitting this DECLARATION, the SUBMITTER expresseshis/her interest in cooperating with the Chamber of Digital Economy based in Warsaw and declares that he/she meets the conditions pursuant to Art. 1 para5 of the Statute / Art. 1 para6 of the Statute[2]and undertakes to comply with the Chamber's Statute,resolutions of the Chamber’s organs, the Code of Ethics, as well as to provide support for the Chamber in pursuing its statutory objectives in accordance with the Statute and the concluded partnership agreement.

  1. Statements

The SUBMITTER declares that the CONTACT PERSON indicated in point 2 of the DECLARATION is fully empowered to represent the SUBMITTER vis-à-visthe e-Chamber, including the updating of all SUBMITTER’s data after admitting him/her as an e-Chamber’s Partner.

The SUBMITTER agrees to convey any information, notice, request, invitation and other statementaddressed to him/her to the CONTACT PERSON or at the e-mail address specified in para2 of the DECLARATION and confirms that the e-Chamber’s notifications of any statement made in this way shall constitute an adequate manner of notifying the SUBMITTER.

The SUBMITTER acknowledges that any information, notice, request, invitation and other statementsubmitted by the CONTACT PERSON or from the e-mail address specified in para2 of the DECLARATION shall be deemed as submitted by the SUBMITTER.

The SUBMITTER declares that the e-mail address specified in para 2 of the DECLARATION is the address that shall be used by the SUBMITTER, after admitting him/her as an e-Chamber’s Partner, for the online use of the e-Chamber platform.

After the admission of the SUBMITTERas an e-Chamber’s Partner, the SUBMITTERundertakes to update the information contained in the DECLARATION, without undue delay. This concerns in particular the data referred to in para 1 and 2 of the DECLARATION, otherwise any statement made by the e-Chamber and vis-à-vis the e-Chamber with the use of these datashall be deemed to be duly served.

  1. Data of the person(s) signing the DECLARATION

1. / Name and surname
Function
E-mail address
Telephone number
2. / Name and surname
Function
E-mail address
Telephone number
  1. Signature(s)

______/ ______/ ______/ ______
Town/City / Date / Name and surname(or a stamp) / Signature
______/ ______/ ______/ ______
Town/City / Date / Name and surname (or a stamp) / Signature

AnnexNo. 1

POWER OF ATTORNEY FOR SUBMITTING DECLARATION OF PARTNERSHIP

annex mandatory if the SUBMITTER is represented by an attorney

The SUBMITTER being a natural person:

I, the undersigned, conducting economic activity under the business name “______”with the registered seat in ______, at ul. ______, postal code __-___, hereby authorise Mr/Ms ______to sign and to submit the declaration of partnership on my behalf to the Chamber of Digital Economy based in Warsaw.

______,______

Town/cityDate

______
(Name and surname) / ______
Signature

The SUBMITTER being a legal person / an organizational unit

I/We, the undersigned, acting on behalf of______with the registered seat in ______, at ul. ______, postal code __-___, entered into the register of entrepreneurs of the National Register of Entrepreneurs kept by the District Court ______, __ Economic Division of the National Court Register (KRS) under the number ______(hereinafter referred to as the Submitter), hereby authorise Mr/Ms ______to sign and to submit the declaration of partnership to the Chamber of Digital Economy based in Warsaw, on behalf of the SUBMITTER.

______,______

Town/CityDate

______
(Name and surname) / ______
Signature
______
(Name and surname) / ______
Signature

INSTRUCTIONS FOR COMPLETING THE DECLARATION OF PARTNERSHIP

  1. Blank boxes should be struck.
  1. The person signing the declaration may be a member (members) of the Management Board, attorney, proxy or other person acting under the authorisation pursuant to the legal act or to the SUBMITTER’s statement. In the case in which the authorisation does not arise from the transcript from the register of entrepreneurs of the National Court Register, or other equivalent document issued outside Poland, it is required to fill in the ANNEX No. 1 TO THE DECLARATION.

Annex No. 3

DATA TO DETERMINE THE ANNUAL SALARY

(mandatory annex)

REVENUE levelfrom the electronic and Internet activities referred to in Art. 1 para4 of the e-Chamber’s Statute, for the last completed financial year (in millions of PLN) / 




 / below 0,5
from 0,5 to 0,75
from 0,75 to 1
from 1 to 1,5
from 1,5 to 2
from 2 to 2,5 / 




 / from 2,5 to 5
from 5 to 10
from 10 to 20
from 20 to 25
from 25 to 30
from 30 to 40 / 




 / from 40 to 50
from 50 to 100
from 100 to 200
from 200 to 300
from 300 to 400
above 400
employmentLEVEL at the end of the last completed financial year / 


 / 0
from 1 to 10
from 11 to 20
from 21 to 30 / 


 / from 31 to 50
from 51 to 75
from 76 to 100
from 101 to 150 / 


 / from 151 to 200
from 201 to 250
from 251 to 400
above 401

Signature(s)

______/ ______/ ______/ ______
Town/City / Date / Name and surname (or a stamp) / Signature
______/ ______/ ______/ ______
Town/City / Date / Name and surname (or a stamp) / Signature

Chamber of Digital Economy based in Warsaw, ul. Mokotowska 1, 00-640 Warsaw,

entered into the register of entrepreneurs and the register of associations, other social and professional organizations, foundations and independent public health care centres of the National Court Register kept by the District Court for the Capital City of Warsaw in Warsaw,
12thEconomic Division of the National Court Register (KRS) under the number: KRS 0000474028
NIP (Taxpayer ID No.)701-039-19-22 REGON (Business ID No.) 146832492

1

[1]In the case of entities established outside the territory of Poland, the person submitting the declaration is obliged to attach an extract of the relevant document confirming business activity referred to in Art. 1 para5 or para6 of the Statute

[2]In the case of entities established outside the territory of Poland, the person submitting the declaration is obliged to attach an extract of the relevant document confirming business activity referred to in Art. 1 para 5 or para 6 of the Statute

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