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Application Form for entry into the register
of Authorised Advisers









Background
This application should be completed by entities seeking an entry into the register of Authorised Advisers on NewConnect or the register of Authorised Advisers on Catalyst or both registers, maintained by the Warsaw Stock Exchange. Entry into the register is made on the basis of a written application of an entity seeking such entry in accordance with point 5 of Exhibit 5 to the Alternative Trading System Rules.
Prior to completing this application, the applicant should read the Alternative Trading System Rules in the wording approved in Resolution No. 147/2007 of the Management Board of the Warsaw Stock Exchange dated 1 March 2007 (as amended) and the Exhibits to the Alternative Trading System Rules.
The applicant should present the completed application and enclosures to the Warsaw Stock Exchange in accordance with points 6 to 8 of Exhibit 5 to the Alternative Trading System Rules.
All signatures in the application must be original.
All information presented by entities seeking an entry into the register of Authorised Advisers concerning their application will be treated as confidential information by the Warsaw Stock Exchange and will not be made public, other than contact details and contact persons.
The completed application together with all enclosures should be sent to the following address:
Warsaw Stock Exchange
Listing Department
ul. Książęca 4
00-498 Warsaw, Poland
or by e-mail at one of the following e-mail addresses: autoryzowani@gpw.pl, gpw@gpw.pl, emitenci@gpw.pl
with the following remark: Application Form for entry into the register of Authorised Advisers.
The fee for the submission of an application for an entry into the register of Authorised Advisers in the amount defined in § 4a(1) of Exhibit 7 to the ATS Rules and in § 22 of the Alternative Trading System Rules should be paid to the bank account of the Warsaw Stock Exchange.
Account: 96 1240 6003 1111 0000 4946 2733.
Application Form
We hereby apply for entry into the register of Authorised Advisers in the alternative trading system:
  11. Applicant’s declaration
    The applicant hereby represents that it is seeking an entry into the register of Authorised Advisers in accordance with the Alternative Trading System Rules in the wording approved in Resolution No. 147/2007 of the Management Board of the Warsaw Stock Exchange dated 1 March 2007 (as amended). If granted the status of Authorised Adviser, the entity declares its full compliance with the rules and regulations governing the Alternative Trading System and advisory for issuers in keeping with the requirements of due diligence and integrity.
    The applicant hereby represents that it has attached to this application all information and documents required in accordance with point 7 of Exhibit 5 to the Alternative Trading System Rules:
    1. appropriate documents (or their copies) specifying the applicant’s legal status, such as its articles of association or deed of formation;
    2. excerpt from an appropriate register;
    3. copy of a permit to conduct brokerage business, if the applicant holds such permit;
      1. copies of Certificates of the persons referred to in point 4a;
    4. financial statements for the last financial year of the applicant if other regulations require such statements to be prepared or a written statement to the effect that financial statements are not required to be prepared;
    5. the conflict of interest management procedure;
    6. written declarations of the applicant to the effect that its managing persons and persons employed by it who hold a Certificate referred to in point 4a have not been found, by way of a final court judgment, guilty of committing a fiscal offence, offence against credibility of documents, property, economic relations, trading in money and securities or other offences related to business relations including without limitation those set out in the Trading Act, the Public Offering Act or the Commodity Exchanges Act;
    7. written declaration of the applicant that, according to its best knowledge, no administrative or criminal proceedings are pending against the applicant, its managing persons or persons employed by it who hold a Certificate referred to in point 4a with regard to their activities;
    8. written declaration that the applicant pays its liabilities when due and that as at the application date and within 12 months prior to that date no enforcement proceedings were instituted against it under a final writ of execution;
    9. appropriate powers of attorney if required;
    10. written declaration that the applicant fulfils the condition referred to in point 11a of Exhibit 5 to the ATS Rules;
    11. written declaration to the effect that none of the circumstances referred to in points 4e - 4g of Exhibit 5 to the ATS Rules arises in the case of the applicant;
    12. document confirming the payment of the fee referred to in § 4a.1 of Exhibit 7 to the Alternative Trading System Rules and § 22 of the Alternative Trading System Rules.
    In accordance with point 8 of Exhibit 5 to the Alternative Trading System Rules, the applicant hereby undertakes to:
    1. comply with rules and regulations governing the Alternative Trading System,
    2. promptly notify the Alternative System Organiser of any significant changes to information covered by the application,
    3. promptly notify the Alternative System Organiser of any significant events or circumstances that have or may have a significant impact on correct performance of the Authorised Adviser’s tasks,
    4. co-operate with the Alternative System Organiser to develop the alternative trading system, including searching for new issuers,
    5. provide the Alternative System Organiser with annual reports on the performance of the Authorised Adviser’s tasks.
    12. The applicant hereby represents that all information presented in this application and in the documents covered by the application, in particular information referred to in points 6 to 8 of Exhibit 5 to the Alternative Trading System Rules covered by the application and in other documents which are integrated into the documentation of the applicant seeking an entry into the register of Authorised Advisers, is true, fair and consistent with facts and the legal status. Details of the applicant’s duly authorised representative(s).
    Details of the applicant’s duly authorised representative(s):

Declaration on the mode of receiving invoices
by the Authorised Adviser

VAT invoicing details
and, if required, additional data to be included in the invoice as required by the Authorised Adviser:
Acceptance of electronic invoices
Acting pursuant to art. 106n of the Act of 11 March 2004 on the Value Added Tax (Journal of Laws 2021.685 consolidated text of 14.04.2021, as amended), the Authorised Adviser accepts electronic invoices from the Warsaw Stock Exchange..
E-invoices, correction e-invoices, duplicate e-invoices, accounting e-notes, reminders, calls for payment will be sent electronically as PDF files to the following e-mail address(es) (no more than 2 e-mail addresses):
In the event of any change of the address(es) written above, the Authorised Adviser shall notify GPW of such change in writing or by e-mail.
If any formal or technical obstacles prevent the issuance and transmission of invoices or above mentioned documents in electronic form, then invoices or above mentioned documents will be sent in a hard copy.
The Authorised Adviser may revoke this acceptance at any time. GPW should be notified thereof in writing or in electronic form (at the address: faktury@gpw.pl). However, in such case, the Authorised Adviser must agree with GPW in writing or in electronic form the date as of which GPW may no longer send invoices in electronic form, which may not be longer than 30 days after the day following the date of GPW’s receipt of the revoked acceptance.
Contact data of the Financial Department or the persons responsible for timely payment of amounts due from the Authorised Adviser:
The Authorised Adviser’s contact person for all matters concerning the payment of amounts due from the Authorised Adviser:
The Authorised Adviser is required to notify any change of data presented in the section “Declaration on the mode of receiving invoices by the entity seeking an entry into the register of Authorised Advisers” in writing at the address of the Warsaw Stock Exchange

Information notice concerning the processing of personal data by the Warsaw Stock Exchange (GPW) in connection with the requirements of Article 13 and Article 14 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation, “GDPR”).

The controller of personal data is the Warsaw Stock Exchange (GPW, ul. Książęca 4, 00-498 Warsaw, Poland, phone +48 22 628 32 32, gpw@gpw.pl).

The controller has appointed a Data Protection Officer who may be contacted at iodgkgpw@gpw.pl.

The scope of personal data processed by GPW includes the first and last name, the business email address, the business phone number, and the job position and, for the entity’s duly authorised representatives, the first and last name, the job position, and data contained in the up-to-date copy of an entry in the relevant register or data contained in the power of attorney.

Personal data of the entity’s duly authorised representatives and data of persons named as business contacts will be processed by GPW in accordance with Article 6(1)(f) GDPR, i.e., for purposes of a legitimate interest pursued by the controller, namely, checking the powers of the entity’s duly authorised representatives in connection with the presented declaration of intent, communications in connection with the submitted application for entry into the register of Authorised Advisers, as well as subsequent communications in matters concerning the performance of obligations of Authorised Advisers, including, among others, the annual report on Authorised Adviser’s activities.

Other data specified in the application for entry into the register of Authorised Advisers, i.e., information about persons holding a certificate, information about the ownership structure and authorities of the Applicant, will be processed by GPW in order to assess whether the entity applying for entry into the register of Authorised Advisers warrants the proper performance of obligations of Authorised Advisers. Data included in the annual report on Authorised Adviser’s activities will be processed for the purpose of its analysis.

The required data are specified in Exhibit 5 to the Alternative Trading System Rules. The scope of the Rules is set out in § 1(1) of the Regulation of the Minister of Finance of 12 April 2019 on the conditions to be met by an alternative trading system or an organised trading platform operated by an investment firm (Article 6(1)(c) GDPR).

Data may be transmitted to personal data processors engaged by GPW in connection with services provided to GPW, e.g., advisory, audit, IT services. GPW may transmit personal data to public authorities if required by applicable law. Personal data may also be transmitted in case of suspicion of crime or fraud, and in such case GPW may transmit the data to a supervisory authority.

Data will be processed within the term of the co-operation and subsequently for a period of time required by law, and stored thereafter for a period of time necessary for the purpose of clearing payments and the establishment, exercise or defence of claims, if any.

Every person has the right to access their personal data, the right to rectification, erasure, restriction of processing, and the right to data portability. Every person has the right to lodge a complaint concerning data processing with the President of the Personal Data Protection Office and the right to object to the processing of their personal data.

Within the limits of the law, every person has the right to object to the processing of their personal data on the basis of legitimate interests of the controller.

In case of the application for entry into the register of Authorised Advisers, the provision of the data is a condition for the execution of the procedure for entry into the register of Authorised Advisers. Failure to provide such data will prevent the execution of the procedure for entry.

Source of data: Personal data may come from the candidate for Authorised Adviser, Authorised Adviser or directly from the data subjects.

The candidate for Authorised Adviser/ Authorised Adviser represents that he/she/it has read the information notice concerning the processing of personal data by the Warsaw Stock Exchange and undertakes to provide such information to the persons whose data is made available by GPW in connection with the procedure of applying for entry into the register of Authorised Advisers and the subsequent operation of the Authorised Adviser in the alternative trading system.