The Authority shall prepare every year the Budget of the Authority for ensuing financial year in Form-C before end of December every year and submit the same to the Government for approval.
By order and in the name of the Governor of Karnataka (Shidramappa H Talawar) Under Secretary to Government, Department of Electronics, Information Technology, Biotechnology and Science & Technology Form– A (See sub-rule (2) of rule 4) Application Form to Establish a Regulatory Sandbox Appendix I: Application form (fill up where applicable) I. Private Agency A. Contact details Applicant Name of the company Company Registration Number (if applicable) Authorised regulatory status (e.g. licensing, registration, notification, approval, recognition) Website URL Name of key personnel (e.g. CEO, CFO) NB: Kindly enclose the curriculum vitae of the personnel e-mail address Phone number 16 Mailing address Shareholders Financial standing, including any funding raised and/or to be raised Describe the nature and scale of your operations in Karnataka (Please keep the response below 200 words) Provide details of high skilled jobs that your company is creating in Karnataka II. Government Agency / Instrumentality Name of the Institution Name of the Designated Officer Authorisation from Competent Authority < Enclose the Letter of Authorisation > e-mail Address Mailing Address Phone Number B. About the product, service or solution Please provide full details of the proposed service/product to be experimented in the sandbox, covering the following areas Describe the product, service or solution (Please keep the response below 200 words.
Additional information may be provided as supporting documents) Eligibility criteria Explain how the product, service or solution is genuinely innovative (Please keep the response below 200 words.
Additional information may be provided as supporting documents) Problem statements that the proposed service/product/ solution aims to address Need for a regulatory sandbox and the proposed sandbox operator Describe how the usefulness and functionality of the product, service or solution has been assessed and/or tested 17 Benefits of the proposed service/product, solution in particular, those that may not exist today, for the people in Karnataka Business model(s), including the target customers and specific use cases. For each use case, provide an end-to-end illustration on how the proposed service/product will be made available in detail.
Technical architecture and solution, detailing the specific technology and innovative ways in which the technology will be applied;
Comparison with existing offerings that are similar to the proposed service/product /solution focusing on the problem statements, benefits, technology and business model; and The readiness of the prototype development, including an estimated timeframe on the readiness to provide an end-toend demonstration of the proposed service/product to the Authority.
Please keep the response below 400 words.
Additional information may be provided as supporting documents) Provide evidence of resources available to support testing in the sandbox (Please keep the response below 200 words.
Additional information may be provided as supporting documents) Explain the business plan for the product, service or solution to be offered on wider commercial scale (Please keep the response below 200 words.
Additional information may be provided as supporting documents) Legal and Regulatory Requirements Please provide full details of the applicable legal/regulatory requirements and the relaxation that you are seeking in order to deliver the proposed service/product/ solution in the sandbox Identify the legal or regulatory requirements that are incompatible with the proposed product Please keep the response below 400 words.
Additional information may be provided as supporting documents) 18 State the regulatory status (e.g.
licensing, registration, notification, approval, recognition) required Please keep the response below 400 words.
Additional information may be provided as supporting documents) Include a legal opinion, if available, from a qualified legal practitioner applying the relevant laws administered by the State of Karnataka to the facts of your case State the specific legal and regulatory requirements that you are seeking KIA to relax for the duration of the sandbox, and why so; and Describe how you intend to meet the full legal and regulatory requirements before exiting the sandbox.
Potential risks and safeguards Please provide full details of the potential risks and safeguards involved in the delivery of the proposed service / product / solution in the sandbox Describe the risks associated with the testing and identify appropriate risk mitigation measures/safeguards (Please keep the response below 400 words.
Additional information may be provided as supporting documents) Describe the controls to be put in place so as to manage risk and failure in the sandbox, including technology risks involved Describe the exit plan from the sandbox and how the good or service or solution is intended to be deployed or operated within Karnataka after exiting from the sandbox Describe how the deployment of this good or service or solution is in larger public interest, including, inter alia, the ability of the good or service or solution to generate employment in Karnataka.
Sandbox Design Please provide full details of the proposed sandbox design, covering the following areas 19 Describe the experiments to be conducted in the sandbox, including specific testing of the application of technology in the proposed service/product / solution.
State and justify the sandbox boundaries Start and end date of the sandbox Limit on the type (e.g. retail, accredited) of customers involved Limit on the number of customers involved Quantification of the maximum loss and impact, including any potential knock-on effects State the geographical area within which the test is to be conducted State the location of the IT infrastructure State the source of funding for the testing Explain the intended key outcomes of the testing Other relevant information Any other information that may support the application 20 Form – B (See Rule 7) Application to Sandbox Operator to participate in a Regulatory Sandbox A. Contact details Applicant Name of the company Company Registration Number (if applicable) Authorised regulatory status (e.g. licensing, registration, notification, approval, recognition) Website URL Name of key personnel (e.g. CEO, CFO) NB: Kindly enclose the curriculum vitae of the personnel e-mail address Phone number Mailing address Shareholders Financial standing, including any funding raised and/or to be raised Describe the nature and scale of your operations in Karnataka (Please keep the response below 200 words) Provide details of high skilled jobs that your company is creating in Karnataka B. About the product, service or solution Please provide full details of the proposed service / product to be experimented in the sandbox, covering the following areas Describe the product, service or solution (Please keep the response below 200 words.
Additional information may be provided as supporting documents) 21 Eligibility criteria Explain how the product, service or solution is within the scope of the Regulatory Sandbox.
(Please keep the response below 200 words.
Additional information may be provided as supporting documents) Explain how the product, service or solution is genuinely innovative, distinct from the available offerings in the same market and explain how it utilises a new technology or existing technology in a novel manner.
Identifiable benefits of the proposed service/product, solution in particular, for the consumers in Karnataka Technical architecture and solution, detailing the specific technology and innovative ways in which the technology will be applied;
Comparison with existing offerings that are similar to the proposed service / product / solution focusing on the problem statements, benefits, technology and business model; and The readiness of the prototype development, including an estimated timeframe on the readiness to provide an end-toend demonstration of the proposed service/product to the Authority.
Please keep the response below 400 words.
Additional information may be provided as supporting documents) Provide evidence of resources available to support testing in the sandbox (Please keep the response below 200 words.
Additional information may be provided as supporting documents) Explain the business plan for the product, service or solution to be offered on wider commercial scale (Please keep the response below 200 words.
Additional information may be provided as supporting documents) Describe the experiments to be conducted in the sandbox, including specific testing of the application of technology in the proposed service / product / 22 solution.
State and justify the requested sandbox boundaries Time Period during which the proposed good or service or innovation may be offered to the prescribed customers.
Limit on the type (e.g. retail, accredited) of customers involved Limit on the number of customers involved Quantification of the maximum loss and impact, including any potential knock-on effects State the geographical area within which the proposed good or service or innovation may be offered to the prescribed customers.
State the location of the IT infrastructure State the source of funding for the testing Explain the intended key outcomes of the testing Describe the measures that will be undertaken to protect data security, confidentiality and consumer privacy Legal and Regulatory Requirements Please provide full details of the applicable legal/regulatory requirements and the relaxation that you are seeking in order to deliver the proposed service/product/ solution in the sandbox Identify the legal or regulatory requirements that are incompatible with the proposed product Please keep the response below 400 words.
Additional information may be provided as supporting documents) State the regulatory status (e.g.
licensing, registration, notification, approval, recognition) required Please keep the response below 400 words.
Additional information may be provided as supporting documents) Include a legal opinion, if available, from a qualified legal practitioner applying the relevant laws administered by the State of Karnataka to the facts of your case 23 State the specific legal and regulatory requirements that you are seeking KIA to relax for the duration of the sandbox, and why so; and Describe how you intend to meet the full legal and regulatory requirements before exiting the sandbox.
Potential risks and safeguards Please provide full details of the potential risks and safeguards involved in the delivery of the proposed service / product / solution in the sandbox Describe the risks associated with the testing and identify appropriate risk mitigation measures/safeguards to protect consumers (Please keep the response below 400 words.
Additional information may be provided as supporting documents) Describe the controls to be put in place so as to manage risk and failure in the sandbox, including technology risks involved Describe the exit plan from the sandbox and how the product or service or solution is intended to be deployed or operated within Karnataka after exiting from the sandbox Describe how this product or service or solution is suited for large-scale deployment after the expiry of the period of testing in the regulatory sandbox Describe how the deployment of this good or service or solution is in larger public interest, including, inter alia, the ability of the good or service or solution to generate employment in Karnataka.
Other relevant information Any other information that may support the application 24 Form - C (See rule 16) Budget of the Authority For the year _________ S.
No.
Expenditure Classification Previous Fiscal Year:
____________ Actual Current Fiscal Year:
__________ Budgeted Next Fiscal Year:
___________ Requested Total Annual Statement of Accounts Receipts and Payments Accounts For the year _____________ S.
No. Receipts Current Year As On (in Rupees) Previous Year As On (in Rupees) S.
No. Payments Current Year As On (in Rupees) Previous Year As On (in Rupees)
1.
To Balance Brought Down 8.
By Chairman and Members
1.1 Bank 8.1 Pay and Allowances
1.2 Cash in Hand 8.2 Other Benefits
2.
To Fee, Charges and Fines 8.3 Travel Expenses
3. To Grants 8.3.1 Overseas
4.
To Income on Investments and Deposits 8.3.2 Domestic
5. To Loans 9. By Officers
6. To Sale of Assets 9.1 Pay and Allowances
7. Others (specify) 9.2 Retirement Benefits
9.3 Other Benefits
9.4 Travel Expenses
10. By Staff
10.1 Pay and Allowances
10.2 Retirement Benefits
10.3 Other Benefits
10.4 Travel Expenses
11. By Wages
12. By Overtime
13. By Honorarium
14.
By Consultation Expenditure
15. By Research 25 Expenditure
16.
By Seminars and Conferences
17. By Publications
18.
By Rent and Taxes
19.
By Interest on Loans
20. By Subscription
21.
By Investments and Deposits
22.
By Loans and Advances
23. By Others / Misc.
24.
By Balance Carried Down
24.1 Bank
24.2 Cash in Hand Total Total Income and Expenditure Account For the year _____________ S.
No.
Expenditure Current Year As on (in Rupees) Previous Year As on (in Rupees) S.
No.
Income Current Year As on (in Rupees) Previous Year As on (in Rupees)
25. To Chairman and Members
41. By Fees, Charges and Fines
25.1 Pay and Allowances 41.1 By Fees
25.2 Other Benefits 41.2 By Charges
25.3 Travel Expenses 41.3 By Fines
26. To Officers 42. By Others (Specify)
26.1 Pay and Allowances 43. By Grants
26.2 Retirement Benefits 44. By Sale of Publications
26.3 Travel Expenses 45. By Gift / Contributions
27. To Wages 46. By Seminars and Conferences
28. To Overtime 47. By Income on Deposits and Investments
29. To Honorarium 48. By Miscellaneous Income
30. To Consultation Expenditure
31. To Other Office Expenses
32. To Research Expenditure
33. To Seminars and Conferences
34. To Publications of the Innovation Authority
35. To Rent and Taxes
36. To Subscription 26
37. To Other Expenses
38. To Depreciation
39. To Excess of Income over Expenditure
40. To Provision of Bad Debts Total Total Member(s) (Signature) Chairperson (Signature) Balance Sheet as on _____________ S.
No. Liabilities Current Year As on (in Rupees) Previous Year As on (in Rupees) S.
No. Assets Current Year As on (in Rupees) Previous Year As on (in Rupees)
49. Funds 53. Fixed Assets
49.1 Capital Fund 54.
Capital Work-in- Progress
49.2 Excess of Income over Expenditure 55.
Investments and Deposits
49.3 Other Funds (Specify) 56. Loans and Advances
50. Reserves 57.
Cash and Bank Balances
51. Loans 58. Other Current Assets
52.
Current Liabilities and Provisions Total Total Accounting Policies and Notes:
Member(s) (Signature) Chairperson (Signature) 27 Annexure – I (See sub-rule (2) of rule 4) Fee Structure for Application for Establishing Regulatory Sandbox Processing Fees for Government Agency - NIL Processing Fees for Companies(Rs.)
Paid Up Capital - Up to 50 Million (5 Crores) Rs. 5,00,000/- + (18% GST) Paid Up Capital - Up to 50 to 100 Million (5 -10 Crores) Rs. 10,00,000/- + (18% GST) Paid Up Capital - Up to 100 to 150 Million (10 -15 Crores) Rs. 15,00,000/- + (18% GST) Paid Up Capital - Up to 150 to 500 Million (15 -50 Crores) Rs. 20,00,000/- + (18% GST) Paid Up Capital - Up to 500 to 1000 Million (50 -100 Crores) Rs. 25,00,000/- + (18% GST) Paid Up Capital - Above 1 Billion (Above 100 Crores) Rs. 30,00,000/- + (18% GST) Paid Up Capital - Above 10 Billion (Above 1000 Crores) Rs. 40,00,000/- + (18% GST) 28 Annexure – II [See rule 7 (2)] Fee Structure for Application for Participation in Regulatory Sandbox Processing Fees for Companies(Rs.)
Paid Up Capital - Up to 50 Million (5 Crores) Rs. 20,000/- + (18% GST) Paid Up Capital - Up to 50 to 100 Million (5 -10 Crores) Rs. 40,000/- + (18% GST) Paid Up Capital - Up to 100 to 150 Million (10 -15 Crores) Rs. 60,000/- + (18% GST) Paid Up Capital - Up to 150 to 500 Million (15 -50 Crores) Rs. 80,000/- + (18% GST) Paid Up Capital - Up to 500 to 1000 Million (50 -100 Crores) Rs. 1,00,000/- + (18% GST) Paid Up Capital - Above 1 Billion (Above 100 Crores) Rs. 2,00,000/- + (18% GST) Paid Up Capital - Above 10 Billion (Above 1000 Crores) Rs. 4,00,000/- + (18% GST) By order and in the name of the Governor of Karnataka (Shidramappa H Talawar) Under Secretary to Government, Department of Electronics, Information Technology, Biotechnology and Science & Technology ಮುದÎಕರು ²ಾಗೂ ಪÎ�ಾಶಕರು:- ಸಂಕಲ£ಾĩ�ಾĸಗಳ�, ಕ£ಾ�ಟಕ ªಾಜÍಪತÎ, ಸ�ಾ�ĸ �ೇಂದÎ ಮುದÎ�ಾಲಯ, ¦ೆಂಗಳ�ರು R.N.I. No. KARBIL/2001/47147 POSTAL REGN. No. RNP/KA/BGS/2202/2017-19 Licensed to post without prepayment WPP No. 297