Annex I
(Version: 2.0)[1]
Application Form for the Provision of Services under the e-Commerce Grant Scheme
Registered Name of Service Provider / (BLOCK LETTERS)Registration No[2].
VAT Number
Official Address
e-mail address
URL: website
Profile of applicant Service Provider
Resources / Name & Surname
(Lead Expert) / (BLOCK LETTERS)
ID No.
Designation / (BLOCK LETTERS)
Curriculum Vitae attached
Copy of relevant academic qualification certificate
Competence and Expertise
Resources / Name & Surname
(Optional Additional Lead Expert) / (BLOCK LETTERS)
ID No.
Designation / (BLOCK LETTERS)
Curriculum Vitae attached
Copy of relevant academic qualification certificate
Competence and Expertise
Include a brief description of the methodologies adopted by the Service Provider in line with the Guidelines for Service Providers issued by the Intermediate Body.
Include a specific list of reference sites that the Service Provider has developed outlining at least:
- Two fully functional websites based on a Content Management System.
- One fully functional e-commerce site having an integrated payment gateway with an online product/service catalogue, a shopping cart, and a payment or booking system enabling online payments.
Declaration / I declare that (insert name of applicant service provider), is an economic operator having the competence and expertise in the provision of services to Micro, Small and Medium-sized enterprises operating across different sectors of the economy, to design, develop and implement and deliver e-commerce websites, mobile applications that enable online payment through the integration of online payment gateways as defined in the Guidelines for Service Providers issued by the IB.
Services shall only be provided to external undertakings which are autonomous and unrelated to the Service Provider.
By submitting this application for enrolment (insert name of applicant service provider) is accepting to provide services in line with the binding guidelines for e-commerce Service Providers issued by the Intermediate Body from time to time.
The applicant accepts that the Intermediate Body will conduct the necessary checks to confirm that the services provided are in line with these guidelines.
Organisation Authorised Representative / Name / (BLOCK LETTERS)
Surname / (BLOCK LETTERS)
I.D. No.
Official e-mail
Telephone No.
Designation / (BLOCK LETTERS)
Signature
Date
Official Stamp
FOR OFFICIAL USE BY THE IB ONLY
Application No.
Date and Time of receipt
Application Approved / Registration approved for the provision of services for the design, development and implementation and delivery of e-commerce websites and mobile applications for Micro, Small and Medium-sized enterprises.
Registration No.
Application Rejected / Name
Surname
Designation
Signature
Official Stamp
Date
Name
Surname
Designation
Signature
Official Stamp
Date
Data Protection Declaration -
Personal Data supplied to the Measures and Support Division (MSD) within the scope of implementation of projects being co-financed by Cohesion Policy funds is processed, in accordance with the Data Protection Act (2001) and any subsequent amendments, by MSD and by other stakeholders and competent authorities mandated to implement, monitor, execute payments, controls and audit the project/contract.
[1] Update to Version 1 Issue Date: 5th August 2016. Changes in this version reflect the changes in the nomenclature of the Ministry.
[2] The Registration Number in terms of the Companies Act – Chapter 386.