Reference number
To be filled in by the Executive Agency

Application Form

MEDIA Sub-Programme Application Form

Programme / CREATIVE EUROPE
Sub-programme / MEDIA
Call for proposals / EAC/S21/2013
Action / Support for the distribution of non-national European films
The "Sales Agents Scheme"
Sub-Action: / Module 1: Minimum Guarantee
Deadline for submission
please note that as from 01/01/2015 the reinvestment projects will be submitted on-line through an eForm / 01/03/2016
Film title
Language used to complete the form
Part A. Identification of the applicant
Organisation PIC number
A.1 ORGANISATION
Full name of the organisation:
Full name of the organisation in Latin characters (if applicable)
Acronym:
VAT number
Registration number
Street: / Number
Post code: / Town:
Country: / Region:
Internet address:
Telephone 1: / Telephone 2: / Fax:
A.2. PERSON RESPONSIBLE FOR THE MANAGEMENT OF THE APPLICATION (CONTACT PERSON)
Title: / Family name: / First name:
E-mail address:
Role in the organisation:
Fill in the following data if the address is different from address provided in section A.1
Street / Number:
Postcode: / Town:
Country: / Region:
Telephone 1: / Telephone 2: / Fax:
Fill in the following information if the Legal representative is different from the contact person
A.3. PERSON AUTHORISED TO REPRESENT THE ORGANISATION IN LEGALLY BINDING AGREEMENTS (LEGAL REPRESENTATIVE)
Title: / Family name: / First name:
Role in the organisation: / E-mail address:
Fill in the following data if the address is different from address provided in section A.1
Street / Number:
Postcode: / Town:
Country: / Region:
Part B. Organisation and activities
B.1. STRUCTURE
Status:
Please tick the relevant box / Public
Private
PART C. Description of the project
C.1. FILM
Please check the following page if the film has been submitted and qualified.
If the information on the film has already been supplied to the Agency as a part of an application in response to previous calls for proposals, it does not need to be supplied on this occasion.
A. FILM ALREADY QUALIFIED BY THE MEDIA UNIT
ORIGINAL FILM TITLE
Film ID code
(please consult to get the code)
Film Director
International film title
B. NEW FILM TO BE QUALIFIED BY THE MEDIA UNIT
ORIGINAL FILM TITLE
International film title
Local film title
C.1.1 Cast & Crew
Name / Nationality / Country of residence
Director name:
Script writer:
Main cast
Actor 1:
Actor 2:
Actor 3:
Composer:
Photo director:
Production designer:
Editor:
Sound:
Shooting location:
Laboratory:
This film is the director's: 1st film
2nd film
3rd or subsequent
C.1.2. Information regarding the film
Genre: Fiction Documentary Live-action children film Animation
Length (in minutes): / Format:
Date start of principal photography:
Date of completion of principal photography:
Shooting language:
Year of copyright:
Cost of production in local currency: / Currency:
Cost of production in EUR:
C.1.3. Financing plan of the film (please provide the financing plan, including the Total Production Cost, certified by the lead producer. The Financing plan should identify the (co)producer(s) of the film (as officially credited), their nationality and their share in the (co)production.
Statement of confidentiality; the above requested document is strictly for the internal use of the MEDIA sub-Programme and for qualification purposes only.
Producer (or lead producer in case of international co-productions):
Name of the company / Town / Country / % in the production
Co-producers:
Name of the company / Town / Country / % in the production
TOTAL
C.1.4. Film synopsis:

MODULE 1 – MINIMUM GUARANTEE

C.2.INFORMATION ON THE PROJECT
C.2.1. Information on the International Salescontract:
Name of the producer:
Name of Sales Agent:
Add as many lines as needed
Type of contract:
(Please tick the relevant box) / deal memo
long-form
frame agreement + letter confirming film title
Date of signature of the contract:
Dd/mm/yyyy
Territoriesacquired in the Int. Salescontract:
(for theatrical rights only)
Start date of the license:
Dd/mm/yyyy
End date of the license:
Dd/mm/yyyy
Duration
Rights aquired(Please tick the relevant box)
Theatrical rights Video rights
Pay TV Free TV
Internet rights
Type of deal with the applicant:
(Please tick the relevant box) / minimum guarantee
flat free
co-production
percentage remuneration deal
Minimum Guarantee
Total amount of MG in currency of contract:
Currency:
Total amount of MG in EUR:
(rate of amount of the month of application if applicable)
Effective dates of payment of the minimum guarantee (if known, otherwise as per contract)
IMPORTANT: in accordance with the Guidelines (Art 8.2), Reinvestment of the potential fund into completed actions (ie. MG fully paid before submission of the application is impossible). / % / Amount in currency / Date of payment
C.3. Budget
C.3.1 Expenses
Total amount of MG in Euro
Deductions (MG paid before eligible period)
TOTAL ELIGIBLE AMOUNT OF MG
C.3.2 Financing plan
Contribution requested from the MEDIA sub-Programme (max. 50%, 60%)
Other public support
Contribution financed by the Sales Agent
TOTAL
C.4 Bank account details
Should my application be selected for EU funding any payments by EACEA should be made to the following bank account: (If this is a new bank account you must fill in the Financial Identification Form and attach it on the Participant Portal. The form can be found at :
IBAN number

Please send together with your application the following documents:

Annex 1: Declaration of honour signed by the legal representative of your organisation
Annex 2 : International Sales contract
Annex 3 : Financing plan of the film (in thecase the film has not been qualifiedby MEDIA)

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