Prior to completing the ORLEN Accelerator application form, please read and accept the Programme Rules and the General Terms and Conditions of Cooperation (GTCC), General Terms of Service ("GTC") for ANWIL S.A., General conditions for the purchase of goods by PGNiG TERMIKA S.A., General Terms and Conditions of Cooperation for Energa Group and General Terms and Conditions of Cooperation for Unipetrol.

I confirm that I have read and accept:

Pursuant to the Programme Rules, the controller of your personal data is ORLEN S.A., with its registered office at ul. Chemików 7, 09-411 Płock, Poland. Additional controllers of your personal data in roud XX are: ENERGA Group, ANWIL S.A., PGNiG TERMIKA S.A., Unipetrol. Personal data is processed for the purposes and to the extent required to participate in the Orlen Accelerator. Provision of personal data is voluntary, but failure to provide such data will make it impossible to register for and participate in the acceleration programme. For details of personal data processing, see the Programme Rules.

The ORLEN Group companies may be interested in using your Application. If you wish your Application to be forwarded to an interested ORLEN Group company, you have to grant your voluntary consent to receiving commercial information from ORLEN Group companies:

I consent to receiving information sent to the email address I have provided.

The Startup's represents and warrants that:

is solely entitled to the intellectual property rights to the Product (IP) and they are not encumbered with the rights or claims of third parties;
is entitled to dispose of the full rights to IP on his own behalf;
the use by ORLEN or a company of the ORLEN Group of the IP, in particular as part of the performance of the Agreement, will not infringe any third party rights;
to use the Product by ORLEN or a company from ORLEN Capital Group, it is not necessary to obtain any additional consent or additional intellectual property rights.

Documents for download:

Template of the Acceleration Agreement
Template of the Implementation Plan
Template of the Implementation Plan - attachments no. 1 and 2

Name:

Full name of the person submitting an Application/ Position at the Company

Telephone No.

Email address

Website:

Country of origin:

Commercial operations commenced on

Calls in the ORLEN Accelerator

Presenting the approach to a selected call using the solution developed by the start-up

Information about the status of a given solution

Identifying and describing benefits for ORLEN from the application/use of the solution – reasons for the data provided, and defining the estimated minimum expected effects of the implementation.

Proposed rules of cooperation with ORLEN, including the post-acceleration settlement model.

Information on key resources (personnel/infrastructure), investor involvement as well as key client and industry credentials

Estimated budget of the pilot project and the minimum expected engagement of ORLEN, including in terms of infrastructure (e.g. the number of service stations to be covered by the pilot implementation)

Estimated TCO (Total Cost of Ownership) with key elements for full scale implementation (for the scale proposed by the start-up)

Revenue figures for the previous financial year

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