ENERGY Call for proposalS 2017
APPLICATION FORM
PART A
General information
Title of the proposed Action
TENtec number
Application Form Part A
/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A1
TENtec proposal number
General Information on the Proposed Action
Call for proposals / CEF-Energy-2017 ▼
Call priority / Not applicable ▼
Call sub-priority / Not applicable
Title of the proposed Action
Proposal type / ▼
Start date of the proposed Action / End date of the proposed Action
Scope and objectives of the proposed Action (up to 2000 characters)
Information on the Project of Common Interest
Project of Common Interest 1
Commission Delegated Regulation (EU) 2016/89 Project of Common Interest number: / ▼
Title of the PCI
Energy Sector
Priority Corridor
PCI Description
Location
Regions
Project of Common Interest 2
Commission Delegated Regulation (EU) 2016/89 Project of Common Interest number: / ▼
Title of the PCI
Energy Sector
Priority Corridor
PCI Description
Location
Regions
….
Application Form Part A/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A2
TENtec proposal number
List of Applicants
Applicant number / Applicant legal name / Legal status / Country
1
2
…
The coordinating applicant leads and represents all of the applicants in the proposal and acts as the point of contact with INEA during the application phase. Designating a coordinating applicant is an option, but not an obligation.
Coordinating ApplicantApplication Form Part A
/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A2.1
TENtec proposal number / Applicant number
Applicant
Applicant legal name
Legal address
Street
City
Postal Code
Country
Legal Status of the Applicant
Applicant legal status / ▼
1. EU Member State
2. Third country
3. Public sector undertaking or body established in the EU
4. Private sector undertaking or body established in the EU
5. Public sector undertaking or body established outside the EU
6. Private sector undertaking or body established outside the EU
7. International organisation
8. Joint Undertaking established in the EU
Does the applicant have the legal personality in accordance with the applicable national legislation?
YES
NO
If NO, then applicants must upload their statutes (or the relevant abstract) in the TENtec eSubmission module to demonstrate that the representative of the applicant has the capacity to undertake legal obligations on its behalf and offer guarantee for the protection of the EU financial interests equivalent to that offered by legal persons.
/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A2.2
TENtec proposal number / Applicant number
Applicant's legal name
Contact Points
Person in charge (first point of contact for the EU, if necessary)
Last name(s) / First name(s)
Function
Is the address different from the legal address? / YES / NO
Street
City
Postal code
Country
Phone
Representative authorized to sign this application
Last name(s) / First name(s)
Function
Is the address different from the legal address? / YES / NO
Street
City
Postal code
Country
Phone
Additional representative authorized to sign this application
Last name(s) / First name(s)
Function
Is the address different from the legal address? / YES / NO
Street
City
Postal code
Country
Phone
Date
Signature
9
Application Form Part A/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A2.3
TENtec proposal number / Applicant number
Applicant's legal name
Implementing Bodies
Implementing body's legal name
Legal status / ▼
Legal address
Street
City
Postal code
Country
EU Member State Approval
EU Member State Ministry's legal name
Legal address
Street / Number
Street
City
Postal code
Country
Representative authorized to sign this proposal
Family name(s) / First name(s)
Function
Is the address different from the legal address? / YES / NO
Street / Number
Street
City
Postal code
Country
Phone
Date
Signature of the competent EU Member State Ministry
9
Application Form Part A/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A2.4
TENtec proposal number / Applicant number
Applicant's legal name
Affiliated Entities
Affiliated entity's name
Legal status / ▼
Legal address
Street
City
Postal code
Country
9
Application Form Part A/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A3.1
TENtec proposal number
Location of the Action
Member State(s) / ▼ / ▼ / ▼ / ▼ / ▼
Region(s) / ▼ / ▼ / ▼ / ▼ / ▼
Third country / ▼ / ▼ / ▼ / ▼ / ▼
NUTS 2 nomenclature will be used for the regions.
Activities of the ActionActivity number / 1, 2, 3…
Activity name
Implementing applicant(s)
Activity description
Indicative start date
Indicative end date
Verifying milestone(s)
Milestones of the Action
Milestone number / Milestone description / Milestone summary / Indicative completion date / Means of verification
1
2
3
…
Application Form Part A
/ EUROPEAN COMMISSION / CONNECTING EUROPE FACILITY
ENERGY / A3.2
TENtec proposal number
Financial information on the Action
Sources of Financing
Financing sources / Amount of financial contribution to the action eligible costs (EUR)
[Applicant 1] / Amount of financial contribution to the action eligible costs (EUR)
[Applicant N] / Amount of financial contribution to the action eligible costs (EUR)
[Total]
1. CEF Energy financing / […] / […] / […]
2. Applicant's own resources / […] / […] / […]
3. CBCA contribution / […] / […] / […]
3. EIB loan / […] / […] / […]
4. Other loans / […] / […] / […]
5. State budget(s) / […] / […] / […]
6. Regional/local budget(s) / […] / […] / […]
7. Income generated by the proposed Action / […] / […] / […]
8. Other sources / […] / […] / […]
Total / […] / […] / […]
Indicative breakdown of estimated eligible costs by activity
Co-financing rate
Activities / 2017 / 2018 / (…) / 2024 / Estimated total eligible costs / Requested co-financing rate / Requested CEF Energy financing /
Activity 1 / […] / […] / […] / […] / […] / […] / […]
Applicant 1 / […] / […] / […] / […] / […] / […] / […]
Applicant N / […] / […] / […] / […] / […] / […] / […]
Activity N / […] / […] / […] / […] / […] / […] / […]
Applicant 1 / […] / […] / […] / […] / […] / […] / […]
Applicant N / […] / […] / […] / […] / […] / […] / […]
Total / […] / […] / […] / […] / […] / […] / […]
Related Actions
If the proposed Action is part of a PCI previously supported through EU funding, please specify all related Actions:
Action title / Funding programme / Grant Agreement/Decision number / Awarded amountExchange Rate
If applicable, please indicate the exchange rate used for preparing the application:
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