DIRECTORATE GENERAL
ECONOMIC AND FINANCIAL AFFAIRS
Fiscal policy and policy mix
Euro protection and euro cash
"PERICLES 2020" PROGRAMME
CALLFORPROPOSALS 2017 ECFIN 004/C5
Standard grant application form
TITLE OF THE PROJECT:
DATE:
PLACE:
Important: The standard forms referred to in the present Call for Proposals, as well as the Pericles 2020financial guidelines for applicants and model of grant agreement can be consulted and/or downloaded from the following link Directorate General Economic and Financial Affairs' dedicated website to calls for proposals. Then, please further select the relevant call under reference 2017 ECFIN 004/C5
.
1.IDENTITY OF APPLICANT
1. 1. Identity of applicant[1]:Business name (full legal name):
Short name (where applicable):
Acronym (where applicable):
Registration documents provided in previous Commission procedures: yes □ no □
1.2. Address of registered office:
Street:
No.:
Postcode:
City/Town:
Country:
1.3.a. Legal representative:
Name:
Position:
Address:
Tel:
Fax:
E-mail:
1.3.b. Contact person (if different from legal person):
Name:
Position:
Address:
Tel:
Fax:
E-mail:
1.4 Particulars of applicant's bank[2]
Branch:
Street:
No:
Postal code:
Town/city:
Country:
Bank code:
Account No:
BIC CODE (SWIFT):
IBAN:
Nameaccount holder:
Registration documents provided in previous Commission procedures: yes □ no □
1.5.a.Brief description of the applicant's activities, general aims and activities in the fight against fraud, describing the applicant's operational capacity.
1.5.b. Declaration concerning VAT eligibility:
Is the type of action for which you request financing under the Pericles 2020 Programme related to those specific and exclusive duties of your office? Please write yes or no:
1.6.Union grants, procurement contracts or loans obtained directly or indirectly during the least three years from a European institution or agency.
For each grant or contract please specify:
Union programme in question:
title of the operation:
Unioninstitution awarding:
year of the award by the Commission and the duration of operation:
amount of the contract, grant or loan:
1.7. Grant applications submitted (or due to be submitted) to European institutions in the current year
For each grant, contract or loan, please specify:
Union programme in question:
title of the operation:
Unioninstitution awarding:
anticipated duration of the operation:
amount of the contract or grant:
N.B. Applicants shall immediately inform the ECFIN -Unit DDG1.C.5Euro protection and euro cash - of any request for funding submitted or, or approved by, other Commission departments and UnionInstitutions after this application.
1.8. Verification of exclusion criteria
Applicants and their affiliated entity(ies) must declare on their honour that they are not in one of the situations of exclusion as listed in the standard form, which can be downloaded from the following website:
For low value grant applicants (≤ 60 000 EUR): the aforementioned declaration is not required.
1.9. Verification of financial capacity
For public bodies: the verification of the financial capacity is not applicable.
For low value grantapplicants (≤ 60 000 EUR): By signing the current application form the applicant declares to have the financial capacity to carry out the action.
For other applicants: By signing the current application form the applicant declares to have the financial capacity to carry out the action.
In addition,a simplified presentation of the balance sheet andprofit & loss account for the last two years for which accounts have been closed must be provided. The standard form can be downloaded from the followingwebsite:
2.DETAILS OF THE MEASURE FOR WHICH A GRANT IS REQUESTED
2.1 Detaileddescription of the measureDetailed description of the action:
Brief description of the specific objectives:
2.2. Expected results of the activity for which the grant is requested
2.3 Summary timetable for implementation and draft programme
Please enclose acalendar of the implementation of the action which refers to every step necessary to carry out the action, from the preparatory phase to the evaluation.
Please enclose a detailed draft programme/agenda of the action, including the subjects covered, the prospective speakers and an indication of the time allocated to the sessions.
2.4. Target group of the action:
Profile of participants (work area, level)
Origin of the participants (country, organisation)
2.5. Number of participants and length of action
Total number of participants
Total number of implementation days[3] of the action
2.6. Total cost of the action (in euro):
2.7.Amount of grant requested from the Commission/ECFIN (in euro):
3. ESTIMATED BUDGET FOR THE ACTION:
The applicant certifies that the costs estimated are necessary for the implementation of the action for which the grant is requested.
Full details of eligible costs and final calculation of the grant amount can be found in the Pericles 2020Financial Guidelines to Applicants and in the model of the grant agreement, which can be foundfrom the following link:
If the applicant uses subcontracting for the implementation of the action, he must respect the following rules:
subcontracting must be justified and may only cover a limited part of the project;
implementing subcontracts must be awarded to the economically most advantageous offer; this means the offer that represents the best relation between quality and price, respecting the principles of transparency, equal treatment of potential contractors and ensuring absence of conflicts of interests.
With regard to staff costs, applicants must describethe functions and tasks of each person involved in the project, together with an estimate of the number of days they will dedicate to the project.
To calculate the budget please download and fill in the budget form (excel document):
4. DECLARATION BY AFFILIATED ENTITY([4])
4.1. Name of the affiliated entity(full legal name):
Please provide proof of legal entity as indicated in pointI.1.
4.2. Verification of exclusion criteria:
Please provide a signed declaration of honour as indicated in point I.8.
4.3. Role, contribution, activities of the affiliatedentity as well as link with the applicant (maximum 10 lines):
4.4.Legal representative:
Name:
Position in the organisation:
The undersigned declares that he/she has read and discussed the project with the applicantin its entirety as submitted in this grant request
______(name and signature)
Done at(place), on (date)
5. DECLARATION BY THE APPLICANT
Person responsible in the applicant organisation for the measure assisted:
Name/forenames:
Title or position in the organisation:
Tel.:
Fax:
E-mail:
I confirm that I have been notified about the fact that according to the Financial Regulation dated 29October 2012[5], applicable to the general budget of the European Union, the applicants who have been guilty of making false declarations are the subject to administrative or financial penalties, envisaged in the regulation aforementioned.
The administrative penalties[6] consist of an exclusion from all contracts and grants financed by the Union budget for a maximum duration of two years from the time when the infringement is established, as confirmed after an adversarial procedure. This period may be extended to three years in the event of a repeat offence within five years of the first infringement. Applicants who have been guilty of making false declarations shall also receive financial penalties representing 2% to 10% of the total value of the grant in question. The rate may be increased to 4% to 20% in the event of repeat offence within five years of the first infringement.
Date: Signature:
Your reply to the grant application will involve the recording and processing of personal data (such as your name, address and CV), which will be processed pursuant to Regulation (EC) No 45/2001 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. Unless indicated otherwise, your replies to the questions in this form and any personal data requested are required to assess your grant application in accordance with thespecifications of the call for proposals and will be processed solely for that purpose by Directorate General for Economic and Financial Affairs. Details concerning the processing of your personal data are available on the privacy statement at the page:
Your personal data may be registered in the Early Warning System (EWS) only or both in the EWS and Central Exclusion Database (CED) by the Accounting Officer of the Commission, should you be in one of the situations mentioned in:
-the Commission Decision 2008/969 of 16.12.2008 on the Early Warning System (for more information see the Privacy Statement on or
-the Commission Regulation 2008/1302 of 17.12.2008 on the Central Exclusion Database (for more information see the Privacy Statement on
6. SUPPORTING DOCUMENTS TO BE ATTACHED TO THE GRANT APPLICATION – CHECK LIST
Reminder: The standard forms can be downloaded from the following linkat Directorate General Economic and Financial Affairs' dedicated website to calls for proposals. Then, please further select the relevant call under reference2017 ECFIN 004/C5
.
Type of form / Who to complete? / Not applicable in case of:
(1) / Application form, accompanied by requested attachments /
- Applicant
- Affiliated entity (points 1.1, 1.2, 1.3 Identity + point 4. Declaration)
(2) / Proof of Legal entity /
- Applicant
- Affiliated entity
- already provided in previous procedures
(3) / Financial identification /
- Applicant
- already provided in previous procedures
- affiliated entity
(4) / Declaration of honour on exclusion criteria and absence of conflict of interest /
- Applicant
- Affiliated entity
- low value grant ≤60000 EUR
(5) / Simplified presentationof balance sheet and profit & loss account /
- Applicant
- public bodies
- low value grant ≤60000 EUR
(6) / Detailed Estimated Budget formfor the action /
- Applicant
1
Commission européenne/Europese Commissie, 1049 Bruxelles/Brussel, BELGIQUE/BELGIË - Tel. +32 22991111
[1] The information given under this category must be based on official documents. The Commission's standard form 'legal entity' can be downloaded from the following address If the required documents have been submitted in previous procedures, the applicant does not need to provide them again.
[2]The Commission's standard form 'financial identification' can be downloaded from the following address If the required documents have been submitted in previous procedures, the applicant does not need to provide them again.
[3]A day of implementation is considered to be a day during which the agenda points of the actionare implemented, with the exception of social events such as welcome/farewell dinners.
[4]Each affiliated entity must complete this declaration. The applicant does not need to complete this section.
[5] Regulation (EU, Euratom) No 966/2012 of the European Parliament and of the Council of 25 October 2012 on the financial rules applicable to the general budget of the Union as amended.
[6] Art. 109 of Regulation (EU, Euratom) No 966/2012 of the European Parliament and of the Council of 25 October 2012 on the financial rules applicable to the general budget of the Union as amended; and Art. 145 of Commission Delegated Regulation (EU) No 1268/2012 of 29 October 2012 on the rules of application of Regulation (EU, Euratom) No 966/2012 of the European Parliament and of the Council on the financial rules applicable to the general budget of the Union as amended.