artiq call –centres of ai exellence

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ARTIQ Call –Centres of AI Exellence Funding application form Institution National Centre for Research and Development, National Science Centre Project Joint National Undertaking: ARTIQ - AI Centres of Excellence Call I Call announcement July 30, 2021 Submission September 20, 2021 – December 20, 2021, 4:00 PM Table of contents I. PROJECT ............................................................................. 3 Funding application number Date of submitting application Call number This is a reference only document. The funding application form is to be submitted exclusively in an electronic version after logging in into the LSI system on NCBR website https://lsi.ncbr.gov.pl/login.php.

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Page 1: ARTIQ Call –Centres of AI Exellence

ARTIQ Call –Centres of AI Exellence

Funding application form

Institution National Centre for Research and Development, National Science Centre

Project Joint National Undertaking: ARTIQ - AI Centres of Excellence

Call I

Call announcement July 30, 2021

Submission September 20, 2021 – December 20, 2021, 4:00 PM

Table of contents

I. PROJECT.............................................................................3

Funding application number Date of submitting application

Call number

This is a reference only document. The funding application form is to be submitted exclusively in an electronic version after logging in into the LSI system on NCBR website https://lsi.ncbr.gov.pl/login.php.

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III. THE APPLICANT..................................................................6V. DESCRIPTION OF REASEARCH AND DEVELOPMENT WORKS ...................................................................................10VI. ACHIEVEMENTS AND EXPERIENCE OF THE LEADER AND RESOURCES AT THE APPLICANT’S DISPOSAL..........................14VII. FINANCIAL PART (PROJECT BUDGET)...............................17VIII. INDICATORS ...................................................................23X. APPENDICES.....................................................................35

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I. PROJECT1. Basic project information

Project title

Project title

Acronym

Project summary

Project summary

2. Project classification

OECD

Area of science and technology –

Level 1

Area of science and technology –

Level 2

Area of science and

technology – Level 3

Dropdown list Dropdown list Dropdown list

OECD” (if applicable)

Area of science and technology -

Level 1

Area of science and technology -

Level 2

Area of science and

technology - Level 3

Dropdown list Dropdown list Dropdown list

NABS

Level 1 Level 2 Level 3

Dropdown list Dropdown list Dropdown list

NACE

Section Department Group Section Department

Dropdown list Dropdown list Dropdown list Dropdown list Dropdown list

MAE

Project pertains the area of energy ¨ yes ¨ no

No of MAE classification Dropdown list

Key words

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3. Project duration

Project start date (format dd/mm/yyyy)

Project end date Populates automatically

Number of months Populates automatically

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II. COST ESTIMATE OF THE PROJECT IMPLEMENTATION

Cost categoriesTask no. Research category

W E OPTotal costs (3+4+5) NCBR Funding

NCN FundingApplicant deductible

1. 2. 3. 4. 5. 6. 7. 8. 9.1 0,002 0,003 0,004 0,00

TOTAL eligible costs:

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III. THE APPLICANT1. Information on the Applicant and the Leader

Applicant’s Identification Data

REGON

Name (full)

Name (abbreviated)

Name of the main organisational unit (if

applicable)

Catalogue of authorised entities Dropdown list

Head office address

Street

Building number

Unit number

Zip code

City/district

Post office

Municipality

County

Voivodship

ePUAP address

Address for correspondence (if different from office address)

Street

Building number

Unit number

Zip code

City/district

Post office

Municipality

County

Voivodship

ePUAP address

Number of the National Court Register/

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CEIDG[Central Registration and

Information on Business]/other registry

NIP(Tax ID)

NACE code for the main activity of the

ApplicantDropdown list

Legal form Dropdown list

Form of ownership Dropdown list

The entity is an organisation conducting

research and disseminating knowledge¨ yes ¨ no

Contact person

First name

Last name

Position

Phone number

E-mail address

Person authorised to represent the Applicant

First name

Last name

Role/Position

First name

Last name

Role/Position

POA for representing the Applicant - Attachment in pdf (if applicable)

Leader’s Identification Data

Leader’s Identification Data

First name

Surname

ID number/identification card number

ORCID

Affiliation/workplace

Phone number

E-mail address

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ePUAP address (if applicable)

Address for correspondence

Street

Building number

Unit number

Zip code

City

Country

IV. PROJECT PURPOSE AND JUSTIFICATION

1. Project objectives and assumptions

Attachment in pdf (if applicable)

2. Practical application of the project outcomes

Description of the practical application of the project outcomes

There are no barriers for the practical application of the project outcomes

3. Novelty of the project outcomes

Level of novelty of project results

o International range

Expected project outcomes

Description of the expected project outcomes

Attachment in pdf (if applicable)

Description of novelty of project outcomes

Description of novelty of project outcomes

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Attachment in pdf (if applicable)

4. Implementation of the project outcomes

4.1. Implementation description

Implementation date

Anticipated date of implementation

Method of project outcomes implementation

Based on market rules, granting a license for utilising Applicant’s

rights to results of industrial research and development works or

development works only (if the project relates to the latter only) in

business activity ran by other companies

¨ yes ¨ no

Based on market rules, selling the rights to results of industrial

research and development works or development works only (if the

project relates to the latter only) for the purpose of introducing

them to business activity of another company with preservation for

the fact that introducing the results cannot pass for disposing for the

purpose of further selling

¨ yes ¨ no

Description of implementation

Implementation risks

Intellectual property

Planned protection of intellectual property rights

No barriers in introduction of project outcomes

Description of the advantages (social/economic/environmental) of introducing project outcomes

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V. DESCRIPTION OF REASEARCH AND DEVELOPMENT WORKS

1. Project implementation methodology

Attachment in pdf (if applicable)

2. Description of research and development works

2.1. GENERAL RESEARCH

Task number

Task name

Task duration (number of months)

Task start month

Task end month

Task objective

Attachment in pdf (if applicable)

Task final outcome – milestone

Name of milestone ParameterDescription of effects of non-achievement of

the milestone

Eligible costs of the task

2.2. INDUSTRIAL RESEARCH

Task number

Task name

Task duration (number of months)

Task start month

Task end month

Task objective

Attachment in pdf (if applicable)

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Task final outcome – milestone

Name of milestone ParameterDescription of effects of non-achievement of

the milestone

Eligible costs of the task

2.3. DEVELOPMENT WORKS

Task number

Task name

Task duration (number of months)

Task start month

Task end month

Task objective

Attachment in pdf (if applicable)

Task final outcome – milestone

Name of milestone ParameterDescription of effects of non-achievement of

the milestone

Eligible costs of the task

2.4. PRE-IMPLEMENTATION WORKS

Task number

Task name

Task duration (number of months)

Task start month

Task end month

Task objective

Attachment in pdf (if applicable)

Task final outcome – milestone

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Name of milestone ParameterDescription of effects of non-achievement of

the milestone

Eligible costs of the task

2.5. SUPPORT FOR ESTABLISHING SPECIAL PURPOSE VEHICLES

Task number

Task name

Task duration (number of months)

Task start month

Task end month

Task objective

Attachment in pdf (if applicable)

Task final outcome – milestone

Name of milestone ParameterDescription of effects of non-achievement of

the milestone

Eligible costs of the task

3. Complementary character of the planned works and research funded under other national and European programmes

4. Project risks

5. Project implementation schedule

Gantt Chartyear year

Category of works 1 Task number… 8 9 10 11 12 … 8 9 10 11 12 … 8 9

1 General research (BNP), industrial research (BP) or development works (PR)/pre-introduction works (PPW), support for establishing special purpose vehicles (SC).

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VI. ACHIEVEMENTS AND EXPERIENCE OF THE LEADER AND RESOURCES AT THE APPLICANT’S DISPOSAL

1. Scientific achievements and experience of the Leader

First name Surname Education Academic title/degree

ORCID

Breaks in the academic career

Career path and professional experience

Project

title

Budget

(EUR)

Source of

financing

Project

duration

Project

carried out

by a

consortium?

Role in

the

project

Main project outcomes

from

(year)

to

(year)

yes/no

Scientific achievements, including the most important publications in the AI area

Attachment in pdf (if applicable)

Achievements in the field of commercialising research outcomes, including in the area of industrial

property rights

Attachment in pdf (if applicable)

2. Experience of the Applicant in R&D projects and commercialisation of project outcomes

Experience of the Applicant

3. Human recourses

Key R&D personnel

First name Surname Education • Academic title/degree (if applicable)

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ORCID

Career path and professional experience

Scientific achievements, including the most important publications in the AI area

Achievements in the commercialisation of research outcomes, including in the area of industrial property

rights

Role in the project

Involvement in the project

Is the person an employee of the Applicant? YES NO

R&D personnel to be employed (if applicable)

4. Administrative resources

5. Project management

6. Technical resources and intangible fixed assets (IFA) necessary for the

project implementation

Access to instruments/infrastructure necessary for the project implementation

Technical resources at the Applicant’s disposal

Resource Purpose Task number

Dropdown list

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Technical resources to be purchased

Resource Purpose Task number

Dropdown list

Intangible assets necessary for project implementation

Intangible assets at the Applicant’s disposal

Resource Purpose Task number

Dropdown list

Intangible assets to be acquired

Resource Purpose Task number

Dropdown list

7. Subcontractors (if applicable)

Is the Applicant planning on engaging subcontractor/subcontractors? ¨ yes ¨ no

8. Data management plan

Attachment in pdf (regarding general research)

9. Ethical issues

Does the planned research require actions related to ethical issues (see

Appendix No. 14 to the Rules and Regulations of the Call)? ¨ yes ¨ no

Description of planned or undertaken actions in the scope of ethics, related to the planned project and

regarding issues mentioned in Appendix No. 14 to the Rules and Regulations of the Call.

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VII. FINANCIAL PART (PROJECT BUDGET)

COSTS OF IMPLEMENTING THE PROJECT

1. GENERAL RESEARCH - NCN

1.1. REMUNERATION (W)

GENERAL RESEARCH

Name of the eligible

cost

Amount of eligible

costJustification Estimation method

Task

number

1.2. SUBCONTRACTING (E)

GENERAL RESEARCH

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

1.3. OTHER DIRECT COSTS (Op)

GENERAL RESEARCH

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

2. INDUSTRIAL RESEARCH, DEVELOPMENT WORKS, PRE-IMPLEMENTATION WORKS, SUPPORT

FOR ESTABLISHING SPECIAL PURPOSE VEHICLES – NCBR

2.1. SALARIES (W)

INDUSTRIAL RESEARCH

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Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

DEVELOPMENT WORKS

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

PRE-IMPLEMENTATION WORKS

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

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2.2. SUBCONTRACTING (E)

INDUSTRIAL RESEARCH

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

DEVELOPMENT WORKS

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

PRE-IMPLEMENTATION WORKS

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

SUPPORT FOR ESTABLISHING SPECIAL PURPOSE VEHICLES

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

2.3. OTHER DIRECT COSTS (Op)

INDUSTRIAL RESEARCH

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

DEVELOPMENT WORKS

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

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PRE-IMPLEMENTATION WORKS

Name of the eligible

cost

Amount of eligible

cost

Justification Estimation method Task

number

Expenses incurred by the Applicant as deductibles

Name of the cost Value of the cost

Total

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3. PROJECT BUDGET - SUMMARY

GENERAL RESEARCH

Cost category Name of the cost

(position/role in the

project)

Amount of eligible cost Subsidy

Remuneration

Total Total

Subcontracting

Total Total

Other direct costs

Total Total

Total Total Total

INDUSTRIAL RESEARCH

Cost category Name of the cost

(position/role in the

project)

Amount of eligible cost Subsidy

Remuneration

Total Total

Subcontracting

Total Total

Other direct costs

Total Total

Total Total Total

DEVELOPMENT WORKS

Cost category Name of the cost

(position/role in the

project)

Amount of eligible cost Subsidy

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Remuneration

Total Total

Subcontracting

Total Total

Other direct costs

Total Total

Total Total Total

PRE-IMPLEMENTATION WORKS

Cost category Name of the cost

(position/role in the

project)

Amount of eligible cost Subsidy

Remuneration

Total Total

Subcontracting

Total Total

Other direct costs

Total Total

Total Total Total

SUPPORT FOR ESTABLISHING SPECIAL PURPOSE VEHICLES

Cost category

Name of the cost

(position/role in the

project)

Amount of eligible cost Subsidy

Subcontracting

Total Total

Total Total Total

PROJECT TOTAL

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Total

Grand total for general

research, industrial

research, development

works, pre-

implementation works

and support establishing

special purpose vehicles

Total

Expenses incurred by the Applicant as deductibles

Name of the cost Value of the cost

Total

VIII. INDICATORS

1. PRODUCT INDICATORS

Applicant

Indicator name Unit Target value

pcs.Number of scientific papers prepared within the CE AI project

and published in highly ranked/leading specialised magazines

of AI area:

Including post-conference materialspcs.

Number of presentations at highly ranked international

conferences (A* or A category) in AI field with presentations

prepared within the CE AI project

pcs.

2. DIRECT OUTCOME INDICATORS

The Applicant

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Indicator name Unit Target value

Number of defended within the CE AI project

dissertations in AI area.pcs.

Number of promoted within the CE AI project

postdoctoral dissertations in AI area.pcs.

Total for the project

Indicator name Unit Target value

Number of created CE AI. pcs.

Number of entities created within the CE AI project for

the purpose of commercialising project outcomes for

instance in the form of special purpose vehicle.

pcs.

Number of project contracts or agreements executed

within the CE AI, including international, in scope of

common science and research projects, development

works, promotions or business enterprises.

pcs.

3. IMPACT INDICATORS

Total for the project

Indicator name Unit Target value

Number of implemented results of projects

implemented within the CE AI project in Poland

pcs.

IX. REPRESENTATION

1. Representations of the Applicant

I hereby represent, that:

I acknowledged the Rules and Regulations of the Call and accept thereby terms.YES/NO

I hereby represent, that:

The application being submitted doesn’t violate the rights of third parties.

YES/NO

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I hereby represent, that:

English language version of the application is identical as Polish language version.

YES/NO

Within this call there are two personal data co-administrators - NCBR and NCN. Below

each of entities transfers informative duties due to co-administrating.

Regarding people whose data has been received by NCBR from them directly.

Pursuant to Art. 13 section 1 and 2 of the Regulation of European Parliament and

Council (UE) 2016/679 of April 27, 2016 on protecting physical persons in relation to

personal data processing and on free transfer of such data as well as lifting the

directive 95/46/WE (hereinafter referred to as „RODO”):

1) The administrator of personal data is National Centre for Research and

Development with registered office in Warsaw (00-695), ul. Nowogrodzka 47a,

2) The inspector of personal data can be contacted via e-mail: [email protected],

3) Personal data is processed within the Common National Enterprise ARTIQ – AI

Centres of Excellence for the purpose of conducting the procedure of

assessment and selection of project, executing the contract for financing the

project, supervising the performance of project, its evaluation, control, audit,

and assessment of informative and promotion actions, its receipt, appraisal

and financial calculation as well as potential determining, vindicating and

defending claims,

4) Personal data is processed based on Art. 6 section 1 letter e of RODO and Art.

27 of the Act of April 30, 2010 on National Centre for Research and

Development, the processing is necessary for performing the task

implemented in public interest,

5) Providing personal data is the requirement for participation in actions

stipulated in point 3,

6) Personal data shall be processed for the whole time of the occurrence of the

call procedure and for the time of implementing the contract for financing the

project, supervising the performance of project, its evaluation, control, audit,

and assessment of informative and promotion actions, its receipt, appraisal

and financial calculation as well as potential determining, vindicating and

defending claims and shall be stored for archival purposes for the period

compliant with office instruction of NCBR and Unified Substantive File

Register,

YES/NO

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7) The recipient of personal data shall be government agencies and entities

performing public tasks or those acting on behalf government agencies, in

scope and for the purposes, deriving from law provisions, as well as entities

performing services necessary for implementing tasks by NCBR. Such data can

be also transferred to IT partners, entities performing technical and

organisational support,

8) I have the right to access the contents of my personal data, correcting my data

and limit processing my personal data as well as to object,

9) I have the right to submit a complaint to Inspector General for Personal Data

Protection and in member state of my ordinary residence, my workplace or

place of presumed violation,

10) My personal data shall not be transferred to third country,

11) My personal data shall not be subject to automated decision-making process

including profiling.

Regarding people whose data has been received by NCBR from them directly.

Pursuant to Art. 14 section 1 and 2 of the Regulation of European Parliament and

Council (UE) 2016/679 of April 27, 2016 on protecting physical persons in relation to

personal data processing and on free transfer of such data as well as lifting the

directive 95/46/WE:

1) The administrator of personal data is National Centre for Research and

Development with registered office in Warsaw (00-695), ul. Nowogrodzka 47a,

2) The inspector of personal data can be contacted via e-mail: [email protected],

3) Personal data is processed for the purpose of conducting the procedure of

assessment and selection of project, executing the contract for financing the

project, supervising the performance of project, its evaluation, control, audit,

and assessment of informative and promotion actions, its receipt, appraisal and

financial calculation as well as potential determining, vindicating and defending

claims,

4) personal data were obtained from the Applicant in the competition,

5) Personal data is processed based on Art. 6 section 1 letter e of RODO and Art.

27 of the Act of April 30, 2010 on National Centre for Research and

Development, the processing is necessary for performing the task implemented

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in public interest. Categories of processed personal data are the below:

a. First and last name,

b. TAX ID, REGON,

c. Address,

d. Role/Position,

e. Phone number, e-mail address,

f. Education,

g. Title/Degree/Profession,

h. ORCID,

i. Professional experience,

j. Position/role in the project,

k. Vote,

6) Personal data shall be processed for the whole time of the occurrence of the

call procedure and for the time of implementing the contract for financing the

project, supervising the performance of project, its evaluation, control, audit,

and assessment of informative and promotion actions, its receipt, appraisal and

financial calculation as well as potential determining, vindicating and defending

claims and shall be stored for archival purposes for the period compliant with

office instruction of NCBR and Unified Substantive File Register,

7) The recipient of personal data shall be government agencies and entities

performing public tasks or those acting on behalf government agencies, in

scope and for the purposes, deriving from law provisions, as well as entities

performing services necessary for implementing tasks by NCBR. Such data can

be also transferred to IT partners, entities performing technical and

organisational support,

8) I have the right to access the contents of my personal data, correcting my data

and limit processing my personal data as well as to object,

9) I have the right to submit a complaint to Inspector General for Personal Data

Protection and in member state of my ordinary residence, my workplace or

place of presumed violation,

10) My personal data shall not be transferred to third country,

11) My personal data shall not be subject to automated decision-making process

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including profiling.

I hereby represent, that I undertake on behalf of NCBR to perform for the third parties

that such data regard, informative duties deriving from Art. 13 and 14 of RODO and to

meet before all people indicated in the application for financing the project,

informative requirements, mentioned above.

I hereby represent, that:

1) In case of receiving the funds for implementing the project, double financing rule

shall not be breached. Double financing in the meaning of illicit reimbursement in

whole or in part of a particular expense twice from public funds (EU or domestic),

2) The tasks comprehended in the application are not financed from the funds coming

from other sources and the Applicant/Leader is not applying for financing from

other sources.

YES/NO

I hereby represent, that the Applicant: YES/NO

Doesn’t have a right to take off or reimbursement of incurred VAT and because of that

applies for refunding VAT in part within the project. At the same time, undertakes to

return the reimbursed within the project VAT, should the prerequisites come up for

reclaiming or deducting the tax2,

YES/NO

Doesn’t have a right to take off or reimbursement of ultimately incurred VAT; however,

shall not apply now or in the future apply for financing any part of VAT within the

project,

YES/NO

Shall have a right to deduct or be reimbursed of the VAT incurred in relation to actions

comprehended in the application.

YES/NO

I hereby represent, that:

All and any required approvals/positive opinions/permits/consents of the appropriate

bio-ethical, ethical commission or other adequate body, in every case the project

pertains research:

YES/NO

Being medical experiments within the meaning of Art. 21 of the Act of

December 5, 1996 on medical and dentist professions,

YES/NO

Clinical in scope of medical products, equipping medical products or active

medical products for implantation, stipulated in the Act of May 20, 2010 on

medical products,

YES/NO

2 This option should also be marked in case of taking off VAT with pre-index.

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29

Clinical of pharmaceutical products, stipulated in the Act of September 6,

2001 Pharmaceutical Law,

YES/NO

Requiring experiments on animals, YES/NO

On the species of flora, fauna and fungus being subject to protection of

species or within protected areas,

YES/NO

On genetically modified organisms or with the use of such organisms, YES/NO

In scope of energy, nuclear safety or radiological protection. YES/NO

I hereby represent, that:

Preliminary contract/commitment letter of employment by and between the Leader

and Applicant has been effectively executed

YES/NO

I hereby represent, that:

The Applicant is subject to statistical reporting GUS to the extent of submitting PNT-01

form „Report on research and development (R&D)” for calendar year prior to the year

of submitting the application.

YES/NO

I hereby grant consent for providing information for the purpose of performing

evaluations by NCBR or other authorised entities.

YES/NO

I am aware of the results of not keeping throughout the call, the form of

communication with NCBR stipulated in Rules and Regulations of the Call.

YES/NO

On the basis of Art. 105 section 4a and 4a' of the Act of August 29, 1997 Bank Law read

with Art. 13 of the Act of April 9, 2010 on sharing economic information and

exchanging economic data, I hereby grant to NCBR in Warsaw an authorisation to

submit on behalf of entity/entities, represented by me, through the Bureau of

Economic Information InfoMonitor S.A. with registered office in Warsaw, the Bureau

of Credit Information S.A. and the Association of Polish Banks indefinite term

authorisation to share economic data processed by these institutions, to the extent

necessary for evaluating payment credibility and credit risk assessment, for the

purpose of sharing them by the Bureau of Economic Information InfoMonitor S.A. with

registered office in Warsaw with NCBR in Warsaw.

YES/NO

I hereby represent, that:

1. Financing shall not constitute public support,

2. I am aware that submitting the application to NCBR means at the same time

submitting an application to NCN,

YES/NO

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30

3. Acting on behalf of the entity that I represent, in case of obtaining the

financing of the project, I hereby undertake to:

a. Include the project in the task and financial plan of the entity,

b. Provide deductible of the equivalent of at least PLN 100 000 annually

throughout the whole period of financing,

c. Hire a Leader and members of the team designated to implementing

the project in compliance with the application and call terms and

conditions,

d. Hire a Leader for the whole period of implementation of the project,

on the basis of employment contract, full time,

e. Provide conducive conditions for implementing performed tasks,

including sharing office space/laboratory and scientific and research

equipment necessary for implementing such tasks,

f. Provide administrative and financial service for implementing the

project, including supporting the visits and stays of the Leader in

Poland (it can also comprehend babysitting and/or helping Leader’s

partner in finding accommodation – if applicable),

g. Provide full time administrative coordinator dedicated exclusively for

Centre of Excellence AI for the whole period of financing the project,

fluent in English and French,

h. Supervise implementation of the project and adequacy of spent

financial funds,

4. In case of qualifying the application for financing, I hereby grant consent for

posting information of call results on NCN and NCBR websites,

5. I have acknowledged the rules of delivering rulings of the Director of NCN,

6. I grant consent for verifying the application with the use anti-plagiarism

software as well as for posting the application in software’s data base,

7. I have acknowledged the contents of the Code of National Science Centre in

regard to credibility of scientific research and efforts to obtain funds for such

research and I hereby undertake to observe.

I hereby acknowledge that the administrator of personal data is NCN with registered

office in Kraków (30-312), ul. Twardowskiego 16. Data protection inspector can be

contacted at: [email protected]. Full contents of information clause pertaining data

processing is available on the website: https://www.ncn.gov.pl/dane-osobowe.

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31

I agree for delivering correspondence of the call in form of soft copy via electronic

platform ePUAP to ePUAP address indicated in part III.1. The consent refers specifically

to correspondence subject to deliveries of the Act of June 14, 1960 Administrative

Procedure Code.

I am aware that in order to receive correspondence from NCBR through

ePUAP platform, I have to sign an official receipt confirmation i.e., place a qualified

electronic signature or trusted signature.

YES/NO

2. Representations regarding the Leader

I hereby represent, that:

I acknowledged the Rules and Regulations of the Call and accept thereby terms.

YES/NO

Within 2 years prior to closing the submission of applications I hadn’t lived, worked

nor studied in Poland, nor hadn’t led the grant implemented in Poland.

YES/NO

I hereby represent, that:

The application being submitted doesn’t violate the rights of third parties.

YES/NO

Within this call there are two personal data co-administrators - NCBR and NCN.

Below each of entities transfers informative duties due to co-administrating.

Regarding people whose data has been received by NCBR from them directly.

Pursuant to Art. 13 section 1 and 2 of the Regulation of European Parliament and

Council (UE) 2016/679 of April 27, 2016 on protecting physical persons in relation to

personal data processing and on free transfer of such data as well as lifting the

directive 95/46/WE:

1) The administrator of personal data is National Centre for Research and

Development with registered office in Warsaw (00-695), ul. Nowogrodzka

47a,

2) The inspector of personal data can be contacted via e-mail:

[email protected],

3) Personal data is processed within the Common National Enterprise ARTIQ –

AI Centres of Excellence for the purpose of conducting the procedure of

assessment and selection of project, executing the contract for financing the

project, supervising the performance of project, its evaluation, control,

audit, and assessment of informative and promotion actions, its receipt,

YES/NO

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appraisal and financial calculation as well as potential determining,

vindicating and defending claims,

4) Personal data is processed based on Art. 6 section 1 letter e of RODO and

Art. 27 of the Act of April 30, 2010 on National Centre for Research and

Development, the processing is necessary for performing the task

implemented in public interest,

5) Providing personal data is the requirement for participation in actions

stipulated in point 3,

6) Personal data shall be processed for the whole time of the occurrence of the

call procedure and for the time of implementing the contract for financing

the project, supervising the performance of project, its evaluation, control,

audit, and assessment of informative and promotion actions, its receipt,

appraisal and financial calculation as well as potential determining,

vindicating and defending claims and shall be stored for archival purposes

for the period compliant with office instruction of NCBR and Unified

Substantive File Register,

7) The recipient of personal data shall be government agencies and entities

performing public tasks or those acting on behalf government agencies, in

scope and for the purposes, deriving from law provisions, as well as entities

performing services necessary for implementing tasks by NCBR. Such data

can be also transferred to IT partners, entities performing technical and

organisational support,

8) I have the right to access the contents of my personal data, correcting my

data and limit processing my personal data as well as to object,

9) I have the right to submit a complaint to Inspector General for Personal Data

Protection and in member state of my ordinary residence, my workplace or

place of presumed violation,

10) My personal data shall not be transferred to third country,

11) My personal data shall not be subject to automated decision-making

process including profiling.

Regarding people whose data has been received by NCBR from them directly.

Pursuant to Art. 14 section 1 and 2 of the Regulation of European Parliament and

Council (UE) 2016/679 of April 27, 2016 on protecting physical persons in relation to

personal data processing and on free transfer of such data as well as lifting the

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33

directive 95/46/WE:

1) The administrator of personal data is National Centre for Research and

Development with registered office in Warsaw (00-695), ul. Nowogrodzka

47a,

2) The inspector of personal data can be contacted via e-mail:

[email protected],

3) Personal data is processed for the purpose of conducting the procedure of

assessment and selection of project, executing the contract for financing the

project, supervising the performance of project, its evaluation, control,

audit, and assessment of informative and promotion actions, its receipt,

appraisal and financial calculation as well as potential determining,

vindicating and defending claims,

4) Personal data has been obtained from the Applicant within the common

national enterprise ARTIQ – AI Centres of Excellence of the described call,

5) Personal data is processed based on Art. 6 section 1 letter e of RODO and

Art. 27 of the Act of April 30, 2010 on National Centre for Research and

Development, the processing is necessary for performing the task

implemented in public interest.

6) Categories of processed personal data are the below:

a. First and last name,

b. TAX ID, REGON,

c. Address,

d. Role/Position,

e. Phone number, e-mail address,

f. Education,

g. Title/Degree/Profession,

h. ORCID,

i. Professional experience,

j. Position/role in the project,

k. Vote,

7) Personal data shall be processed for the whole time of the occurrence of the

call procedure and for the time of implementing the contract for financing

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34

the project, supervising the performance of project, its evaluation, control,

audit, and assessment of informative and promotion actions, its receipt,

appraisal and financial calculation as well as potential determining,

vindicating and defending claims and shall be stored for archival purposes

for the period compliant with office instruction of NCBR and Unified

Substantive File Register,

8) The recipient of personal data shall be government agencies and entities

performing public tasks or those acting on behalf government agencies, in

scope and for the purposes, deriving from law provisions, as well as entities

performing services necessary for implementing tasks by NCBR. Such data

can be also transferred to IT partners, entities performing technical and

organisational support,

9) I have the right to access the contents of my personal data, correcting my

data and limit processing my personal data as well as to object,

10) I have the right to submit a complaint to Inspector General for Personal Data

Protection and in member state of my ordinary residence, my workplace or

place of presumed violation,

11) My personal data shall not be transferred to third country,

12) My personal data shall not be subject to automated decision-making

process including profiling.

I hereby represent, that I undertake on behalf of NCBR to perform for the third parties

that such data regard, informative duties deriving from Art. 13 and 14 of RODO and to

meet before all people indicated in the application for financing the project,

informative requirements, mentioned above.

I hereby represent, that:

1) In case of receiving the funds for implementing the project, double financing

rule shall not be breached. Double financing in the meaning of illicit

reimbursement in whole or in part of a particular expense twice from public

funds (EU or domestic),

2) The tasks comprehended in the application are not financed from the funds coming

from other sources and the Applicant is not applying for financing from other

sources.

YES/NO

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35

I hereby grant consent for providing information for the purpose of performing evaluations by

NCBR or other authorised entities.

YES/NO

I hereby represent, that:

1. I am the author or co-author of the application,

2. In case of qualifying the application for financing, the results of the project

achieved in the course of implementing the project, shall be evaluated and

published in magazines or publication/publications of international range,

open for access,

3. In case of qualifying the application for financing, I hereby grant consent for

posting information of call results on NCN and NCBR websites,

4. In case of qualifying the application for financing, I undertake to reside on the

territory of Poland for the whole time of the occurrence of the project as well

as to stay at the disposal of the Applicant,

5. I have acknowledged the rules of delivering rulings of the Director of NCN,

6. I grant consent for verifying the application with the use anti-plagiarism

software as well as for posting the application in software’s data base,

7. I have acknowledged the contents of the Code of National Science Centre in

regard to credibility of scientific research and efforts to obtain funds for such

research and I hereby undertake to observe.

I hereby acknowledge that the administrator of personal data is NCN with registered

office in Kraków (30-312), ul. Twardowskiego 16. Data protection inspector can be

contacted at: [email protected]. Full contents of information clause pertaining data

processing is available on the website: https://www.ncn.gov.pl/dane-osobowe.

YES/NO

X. APPENDICES1. Power of attorney for representing the Applicant (if applicable).

2. Representation on the intention to file the application/representations via a computer LSI system

(template for download).

3. Preliminary contract/employment arrangement signed by and between the Leader and the Applicant.

4. The report on research and development activity (R&D) for the year preceding the filing of the

application (if applicable).

5. Information for evaluation purposes (template for download).

6. Data management plan, NCN (template for download).

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7. NCN’s Budget table (template for download).