pif gold medal application form - EKO-LAS to

BIT-BIZNES-INNOWACJE-TECHNOLOGIE sp. z o. o.
ul. Głogowska 26 , 60-734 Poznań
Person in charge: Jolanta Kanikowska
Tel. 61/869 22 06, 61/866 59 36, fax: 61/866 66 50
e-mail: j.kanikowska@binte.pl
Bank account: PEKAO S.A.
IBAN PL 78 1240 6612 1111 0010 3433 8273
SWIFT: PKO PP LPW
PIF GOLD MEDAL COMPETITION APPLICATION
Applications’ deadline: 20.06.2012
Exhibiting of a submitted device at the fair is the condition of the competition’s participation . Please, attach to your application materials facilitating
product’s estimation. If exhibitor is not manufacturer of device submitted to the competition, it should attach relevant declaration or authorization of
manufacturer. Transfer of the competition’s fee and enclosing the copy of the payment’s proof is the condition of participation.
Manufacturer:
Street: Mailing code: Town/City: Region:
Telephone: Fax: E-mail: Internet:
Exhibitor (full name):
Pavilion, stand:
Street: Mailing code: Town/City: Region:
Telephone: Fax: E-mail: Internet:
Entitled person in charge (first name, family name, post, telephone, fax):
WE SUBMIT OUR PRODUCT TO THE COMPETITION
(to be filled in separately for each submitted product)
Fee for each submitted product
600 EURO
Product’s name ( please, write full trade name ):
- in Polish:
...................................................................................................................................................................................
- in English:
..............................................................................................................................................................................
Information about manufacturer ( among others: range of production, traditions, experience, confirmed quality systems e.g. ISO or
other):
Product’s application – aim and range:

Product’s virtues, innovative quality, technology, information of manufacturing (since when, output and sale so far ), market
position, comparison to other similar products , quality control on the levels of plant and product, opinions of important users, price
information in relation to other products:
Commercial information ( output, sale, market attractiveness ) can not reveal commercial secrets, but should describe company’s
size , its market position, importance and significance for industry and whole economy:
Obtained distinctions:
Possessed atests / certificates/ testimonies/ results of examination/ conformity with norms:
List of attachments ( CD presentation, product’s description, characteristic, photos, leaflets, catalogues, samples, drawings ,
product itself etc.):
1. .........................................................................................................................................................................................................
2. .........................................................................................................................................................................................................
3. .........................................................................................................................................................................................................
4. .........................................................................................................................................................................................................
5. .........................................................................................................................................................................................................
I declare that I know and approve competition’s regulations. I confirm verity of information given on this form, I am also aware that submitting of any
false information excludes participation at competition.
I agree for using a photo of submitted product as well as a logo of ……………………………………...(please, write the name of a company ) for
promotional aims of the Gold Medal Competition.
Payer: full company’s name ( for invoicing )
......................................................................................
________________________________
Place and date
......................................................................................
VAT No.:
.............................................................................
_______________________________________
Company’s seal
_________________________________
Legalny binding signature