APPLICATION FORM

Hereby, company _______________________________ submits a request to register as a

resident of the information technology park "MOLDOVA IT PARK" by signing the contract on
carrying out activities in the information technology park "MOLDOVA IT PARK" for a period of
_______________ years 1.
Choose the activities the company will carry out in the Park by introducing [V]:
• customized software development activities (customer oriented software) (62.01);
• computer game editing activities (58.21);
• editing of other software products (58.29);
• management activities (management and operation) of computing means (62.03);
• data processing, web page management and related activities (63.11);
• web portal activities (63.12);
• information technology consulting activities (62.02);
• other information technology service activities (62.09).
• other forms of education (85.59) limited to training in computer science;
• specialized design activities (74.10) based on the use of specialized highperformance computing
equipment.
Research and development in other natural sciences and engineering (72.19), based on the use of
specialized high-performance computing equipment, limited to:
• experimental research and development services in mathematics (72.19.11);
• experimental research and development services in computers and computer science (72.19.12);
• experimental research and development services in physics (72.19.13);
• experimental research and development services in nanotechnology (72.19.21);
• other experimental research and development services in engineering and technology, except
biotechnology (72.19.29);
• research and development services of original projects in natural sciences and engineering, except
biotechnology (72.19.50);
Research and development in biotechnology (72.11), limited to:
• experimental research and development in the field of bioinformatics: database building in genomics,
protein ordination, complex biological modeling processes, including biological systems;
• experimental research and development in the field of nano-biotechnology: nanoscience and micro-
projection tools and processes used in the construction of devices for the study of bio-systems and
applications in medication, diagnostics, etc.;
Manufacture of electronic components (modules) (26.11), limited to:
• manufacture of microprocessors;
• manufacture of integrated circuits (analogue, digital or hybrid);
Cinematographic, video and television program post-production activities (59.12), based on the use of
specialized high-performance computing equipment, limited to:
• services for obtaining special effects (59.12.14);
• animation production services (59.12.15).

1 Minimum term – 4 years, maximum term (2019) – 8 years.

Attention! The document contains personal data processed as part of the Register No.0002205-001, registered in personal data operators
register https://registru.datepersonale.md. Further processing of these data can be performed only under the conditions stipulated by the Law
No.133 as of 08.07.2011 on personal data protection
 The following information is provided for signing the contract on carrying out the activities in
the information technology park “MOLDOVA IT PARK”:

1. Company’s Fiscal Code (IDNO)_____________________________________________

2. Brand name _____________________________________________________________
3. Bank name ___________________________________________________
4. Bank code (SWIFT) ____________________________________________
5. IBAN ________________________________________________________
6. Phone number ___________________________________
7. E-mail __________________________________________
8. Web page _______________________________________
9. Authorized representative _________________________________________
(the power of attorney is attached)
10. Authorized representative’s phone number +373 ____________________________
11. Number of employees __________________
12. Sales revenue in 2017: __________________________MDL
13. Sales revenue in 2018: __________________________MDL
14. Sales revenue in 2019: __________________________MDL
15. Forecasted sales revenue for 2020: ______________________MDL

Hereby, I declare under my own responsibility that the company is not in the process of
liquidation and carry out their entrepreneurial activity on the territory of the Republic of Moldova.
By signing this application, the applicant agrees that the administration of the information technology park
"MOLDOVA IT PARK" will access its information via the Interoperability Governmental Platform MConnect, in
order to ensure the exchange of data and proper verification of provided data etc.

Attention! The document contains personal data processed as part of the Register No.0002205-001, registered in personal data operators
register https://registru.datepersonale.md. Further processing of these data can be performed only under the conditions stipulated by the Law
No.133 as of 08.07.2011 on personal data protection