Personal Data (Of the Expert Executing the Task)

Annex F

FAX REPLY

Please fill in the following information to prepare a Task Contract Letter (if you can confirm your availability):

Personal data (of the expert executing the task) :

Name:

Surname :

Address:

City: Postal code:Country:

Telephone: Fax:

E-mail:

I will carry out the tasks: (tick your option)

Option 1 : through my employer’s organisation (University, Company, …) (at a standard fee of 450 €/day)

Option 2 : as an independent consultant (at a standard fee of 450 €/day)

– I declare that my activities as independent consultant constitute my main professional activity.

–I declare that for this purpose :

Option 2a : I have created a company which is registered in accordance with national legislation

Option 2b :I am in the possession of the status of self-employed person and that social security and professional charges are covered through contributions paid in the context of this professional activity in conformity with relevant national regulations

Option 3 : as a natural person whose activities as independent consultant do not constitute the main professional activity (at a standard fee of 250 €/day)

– Main professional activity :

– I declare that

(i) social security and professional charges are covered through contributions paid in the context of this main professional activity in conformity with relevant national regulations;

(ii) provisions in my contract of employment for this main professional activity (or statutory provisions for civil servants or persons otherwise in public employment) allow for the task to be executed in my personal capacity and paid through my personal account.

Option 4 : as a civil servant or person otherwise in public employment; my statute or contract of employment does NOT allow me to execute the task in my personal capacity and be paid through my personal account (in this case no fees can be paid, travel expenses only may be reimbursed to the public body).

Organisation data (option 1, 2a and 4 only) :

For companies: please send a copy of the official registration or legal status of the company

Legal name of the organisation:

Legal address:

Legal Registration No :

City: Postal code: Country:

Telephone: Fax:

Name of the authorised person who represents the organisation for legal purposes and will sign the

contract:

VAT data (option 1, 2a and 2b only) :

VAT number:

If none, provide reasons for exemption from VAT registration with reference to the relevant national regulations

Banking information:

The Bank must be located in the Contractor's country of residence, and the account must be in the name of the Contractor.

Please provide a bank account identification issued by your bank (RIB : Relevé d’Identité Bancaire).

Alternatively, you may complete and sign the Financial Identification Form attached.

Incorrect or incomplete data on the bank account identification may cause a considerable delay in the processing of payment instructions by the Commission.

Signature (1): Date :

(1) in case of submission by e-mail, the signature should mention “signed”. the date of signature will be the date of sending of the e-mail.

Version 1.1 of 26/9/011