REPUBLIC OF CROATIA
MINISTRY OF SCIENCE, EDUCATION AND SPORT

3C Grant “Research in Industry”– Application Form 2008

Preliminary notices for applicants:

  1. You must read and accept the UKF Guidelines and Procedures 2008, the respective Call for Proposals and the 3A Grant “Research in Industry” – Instructions for applicantsbefore filling out this form.
  2. Information on this form is collected in order to make recommendations to the Ministry of Science, Education and Sport represented by the Unity through Knowledge Fund’s Approval Committee (Prof. Željko Bošnjak, Ph.D., Mr. Ivica Mudrinić, Prof. Ivan Pavić, Ph.D., Prof. Mladen Žinić, Ph.D. and the Minister Prof. Dragan Primorac, Ph.D. as the president of the Committee) on the allocation of financial support within Croatian Science and Technology Project under the Loan Agreement Nr. 7320-HR between Republic of Croatia and International Bank for Reconstruction and Development (Narodne Novine, Međunarodni ugovori br: 12, Loan Nr. 7320-HR).
  3. The information collected may be passed to third parties for assessment purposes.In other instances, information contained in this Proposal can be disclosed without your consent only where authorised or required by law.

A.Project proposal

1.Project info

a.Project title

b.Candidate (firstname(s), family name, title, e-mail, address, phone, private address)

c.Company (full name, address, web address, authorized person details with e-mail and phone,
register number)

2.Summary of the project Word count: (Max. 400 words, add word count)

3.Details on the company

a.Nature of business/types of products sold and/or services offered

b.Estimated revenues, profits and total annual R&D expenditures (EUR)

Previous year
Current year
Next year

c. Croatian ownership (in percentage) %

d.Current number of employees

4.Description of the projectWord count:(Max. 2000 words, add word count)

  1. Rationale and background of the project including the state of the art of the technology
  1. Overall objectives, significance and innovation of the research/technology
  1. Proposed approach and methodology
  1. Expected measurable results
  1. Management of the project, explaining the candidate’s role
  1. Physical resources available for the project
  1. Value of experience and future opportunities for the candidate
  1. Added value contributed by the project

5.Work plan and timetable of the projectWord count:(max. 1000 words, add word count)

  1. Milestones (what and when is planed to be done)

Milestones / Description of activities / Start date / End date
  1. Key performance indicators (quantitative development towards key project goals – half-year achievements)

Key performance indicator / 1st
half-year / 2nd
half-year / 3rd
half-year / 4th
half-year

6.Partnership, owner structure, IPR and obligationsWord count:(max. 500 words, add word count)

a.Collaborations with other organizations

b.Owner structure, obligations and intellectual property rights related to the project

B. Financial plan

Please provide the financial plan on separate spreadsheet table.Provide here just totals.

7.Personnel costs requested from UKFand contribution of thecompany in HRK

Description / Year 1 / Year 2 / Total
a. UKFfunding
b. Company funding
c. Other Croatian public-sector funding
d. Other Croatian private-sector funding
f. Foreign funding (public and rivate)
Totals

C. Annexes

8.CV of the candidate (submitted on the enclosed official Young Researchers and Professionals Program – Curriculum Vitae Form 2008)

9.Please list two persons who wrote two letters of recommendation for the candidate (max. 1 page each)

10.Please list the enclosed letters of commitment (of administering company)(max. 1 page each)

11.Please list enclosed other relevant annexes

D. Project applicant signatures

By signing this proposal, I confirm that:

  1. YES / NO,I have read, understood, and accepted ‘UKF Guidelines and Procedures’.
  2. YES / NO, The proposed research project is in accordance with the obligations, duties, and responsibilities stated in ‘UKF Guidelines and Procedures.
  3. YES / NO, I will notify the UKF Secretariat if there are changes to named participant(s) after the submission of this Proposal.
  4. YES / NO, I will notify the UKF Secretariat if I request support for this research from other organizations or if additional support is granted.
  5. YES / NO, To the best of my knowledge, all details provided in this application form and in any supporting documentation are true and complete and no information is false or misleading

Main applicant

Name: Signature: Date:

E. Signatures of responsible persons of administering organization(s)

Notice:The grant will be awarded to the administering organization (legal entity) that will be engaging and hosting the applicant. This organization expresses its support with the separate Letter of Commitment signed by the authorized person of the organization.

By signing this proposal I certify that:

  1. YES / NO, My organization supports this Proposal and if successful will provide basic facilities and the items listed in the budget and in the separate letter of commitment.
  2. YES / NO, My organization is prepared to have the project carried out under the circumstances set out in this Proposal and in accordance with the ‘UKF Procedures and Guidelines 2007’, including financial administration, employment of co-workers and reporting according to the law.
  3. YES / NO, My organization will undertake all necessary responsibilities and actions concerning the employment of the proposed project’s co-workers according to the law.
  4. YES / NO, My organization will notify the UKF about all conflicts of interest relating to parties involved in or associated with this proposal which arise after the submission of this Proposal.
  5. YES / NO, To the best of my knowledge, all details provided in this application form and in any supporting documentation are true and complete and no information is false or misleading.

Nameand signature of administering company’s responsible person:

Legal Entity:

Name and position:Signature: Date:

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