Reference Number of the Category Under Which This Proposal Is Presented

Directorate-General for Communication

GRANT APPLICATION FORM

Reference number of the category under which this proposal is presented:

(Enter either 01 for Television; enter 02 for Radio; enter 03 Websites)

COMM/2011/ ...... (enter reference number)

ATTENTION

-This reference numberis obligatory; yourproposal will not be evaluated if the category number is not clearly marked on this page.

-Before completing this request for a grant, please read carefully the information provided under the category to which you are submitting your proposal. Please note that only one application per organisation for this Call for Proposals will be accepted. The draft grant agreement and terms and conditions provided in this publication may provide important information and should be read carefully.

-Incomplete forms will not be accepted. Forms must be typewritten and presented in a folder, on A4 paper, not stapled or attached together.

1. Information on the applicant

(In the case of a partnership this page (page 1) should be completed for each partner organisation)

Please complete in Roman characters
1.1 Identity of the applicant[1]
Official name in full:
Short name or acronym:
Official legal form (limited company, charity etc):
Legal capacity:[2]
Company registration number:[3]
VAT number:[4]
Applicant’s official address:

• Street :
• No:
• Postal code:
• City:

• Country:
• Telephone:
• Fax:
• E-mail address:
• Internet site:

Person responsible for the application and for signing the eventual Grant Agreement
(This person must be entitled to enter into legally binding commitments on behalf of the applicant organisation).

• Name:
• Position:
• Telephone:
• Fax:
• E-mail address:

Contact Person: (This will be the only person contacted, and by e-mail only, during the evaluation procedures for requests of additional information and for up-dates on the procedure -please therefore ensure that any messages we may send are relayed to another person in case of absence).

• Name:
• Position:
• Telephone:
• Fax:
• E-mail address:

1.2 Bank details
The account to be used for the action for which a grant is being requestedmust allow payments, made by the Parliament, to be clearly identified
Name of the bank:
Address of branch:
Precise name in which the account is open (normally name of organisation):
Full IBANcode of bank account:
Please ensure that you include the financial identification form annexed to this publication which must be stamped and signed by your banking organisation.
1.3 Applicant’s activities and objectives

• Date on which applicant organisation/company was founded:
• Objectives specified in the applicant's articles of association:

• Applicant’s current main activities:

• Main projects completed or being carried out in the field covered by this application:

1.4 Other community funding
1.4.1 Community grants, procurement contracts or loans obtained directly or indirectly during the last 2 years from a European institution or agency.
For each grant, contract or loan please specify:
(repeat as many times as necessary)

• The Community programme concerned (if applicable):

• Title of the project:
• The European Community Institutionand the department which took the award decision:[5]

• The year of the award and the start and end dates of the operation:

• The value of the grant, contract or loan:

1.4.2 Grant applications or offers of services submitted (or due to be submitted) to European Institutions in the current year and for which no final decision has yet been taken:
For each grant, contract or loan please specify:
(repeat as many times as necessary)

• The Community programme concerned (if applicable):

• Title of the project:
• The European Community Institution and the departmentwhich will take the award decision:
• The planned start and end date of the operation:

• The estimated value of the grant, contract or loan:

NB: The applicant is required to inform without delay the Directorate General for Communication of the Parliament, to which this application is submitted, of any application for funding made to other Parliament departments or Community institutions or any funding approved by them AFTER submission of this grant application.
1.5 Financial viability of the applicant throughout the period during which the plannedaction is to be carried out
This section must show that the applicant has stable and sufficient sources of funding to continue operating throughout the period during which the action is being carried out and to participate in its funding.
In this context the following indicators must be given (for the last two financial years for which the accounts have been closed). Please provide these figures in EURO:
Accounts year N Accounts year N1
Turnover or equivalent:
Net earnings or equivalent:
Total balance sheet or budget:
Medium and long-term debt:
Shortterm debt (< 1 year):
This information does not replace the requirement for the introduction of the official accounts of your organisation referred to at point 7 of the Call for Proposals and necessary for the selection criteria evaluation.
Any guarantees granted by third parties:
Any other factors demonstrating financial viability:
Any risks or uncertainties about implementation:
Staff on official organisational plan (paid on basis of contract of employment) enter the number of:
Full-time staff......
Part-time staff......
1.5.1 TOTAL ESTIMATED COST OF THE ACTION PROPOSED: €
CONTRIBUTION REQUESTED FROM DG COMMUNICATION: €

ANNEX I

2. Information on the actionfor which the grant is requested

2.1 Description of the action
Name of the project:...... (please keep the title brief and make it indicative as to the content of the project being proposed)
Specific objective(s): (explain your objectives in running the action proposed and their relation to the objectives as set out in the call for proposals. Describe the target group(s) and the number of expected participants, detail which sectors the participants will be representing and how they will be selected to participate (viewers, attendees)MAXIMUM ½ PAGE
Detailed description of the action:(please provide a clear and detailed explanation as to what exactly is planned within this project proposal, include dates and times of activities and key stages of the project, include venues for meetings or events, describe in detail the subject matters to be dealt with and how they will be addressed. Please do not submit a proposal which is confusing or badly described- your proposal will not be selected if the evaluation committee are unsure as to what exactly the project consists of )MAXIMUM 6 PAGES
Organisation / implementation: (please describe the overall concept of the project in clear and concrete terms; the way it will be organised; if applicable, please specify the exact tasks relating to the project which the Applicant is planning to subcontract to another organization / company / association-these are tasks that will be paid for against an invoice to another organisation; if applicable detail clearly the tasks which will be carried out directly by the Applicant and which tasks by any Partner organisations)MAXIMUM 2 PAGES
Expected results and their use: (please describe what results you hope to achieve through your project; describe in detail the way in which results will be disseminated (how and to whom); describe what form and method will be employed to publicise your activities and in which ways this will give visibility to the project; please provide a description of exactly what will be delivered to the European Parliament on completion of the project)MAXIMUM 1 PAGE
(use additional pages as necessary)
Would you prefer to receive a grant agreement in English or inFrench? (please indicate)
......
2.2 Duration and summary timetable for carrying out the action
The period during which an action is carried out determines the period of eligibility of the corresponding costs.
(Applicants are informed that, under the financial legislation applicable to the general budget of the European Communities, no grant may be awarded retrospectively for actions already completed. Furthermore expenditure incurred before the signature of a grant agreement will not be considered as eligible expenditure, for the calculation of the final grant amount. Projects that show a start date or an end date outside of the dates set-out in the Call for Proposals will be automatically rejected at evaluation of exclusion criteria stage)
Applicants are requested to indicate and justify:

• the planned dates for starting and completing the action:

Start date:...... (enter date on which activities will commence)
Completion date:...... (enter date on which activities will be completed)

• the timetable for carrying out each stage of the action showing the main key dates and the objectives/expected results for each stage:(use separate sheet where necessary)

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3. Budget estimates for the action for a which a grant is requested ANNEX II
The budget estimates must be detailed, in balance (between eligible costs and financing plan) and presented in Euros.
The applicant certifies that the costs given below are necessary and exclusively related to the implementation of the action.
In the case of a partnership (see guide) this summary table should collate all financial information of all partners to the project in order that each total is the total for all partners for each category of expenditure)
A — ELIGIBLE COSTS / EUROS / B — FUNDING / EUROS
A.1) costs of the staff assigned to the action[6] / B.1) expected direct revenue from the action (such as seminar entrance fees, sales of goods etc.)
A.2) travel and subsistence costs for the staff assigned to the action / B.2) contribution by the applicant
A.3) cost of purchasing new equipment[7] / B.3) contribution by other external sponsors[8]
A.4) costs of consumables and supplies
A.5) sub-contracting costs / B.4) contribution requested from the PARLIAMENT
A.6) indirect costs / overheads [9]
TOTAL COSTS / TOTAL FUNDING

3.1 BREAKDOWN OF ELIGIBLE COSTS BY CATEGORY(In the case of a partnership, each partner organisation should present the following tables for the estimated costs they foresee to incur for their part in running the project, stating clearly the name of the partner concerned at the top of this sheet)

A.1 Personnel costs -

This section refers strictly to staff on the payroll of the organisation. Freelance and sub-contracted persons paid against invoices should be included under the heading "sub-contracting costs"

Name (a) / Function (b)
(position or title in organisation) / Status (c) (permanent/temporary staff) / Full monthly salary cost[10]
€ (d) (do not calculate part months we request the full monthly salary cost) / Duration (e)
to be worked on action
(in months) / TOTAL €
d x e
TOTAL Category

A.2 Travel and subsistence costs

Destination (a)
From - To / Reason for travel (b) / Number of participants (c) / N° of nights foreseen (d) / Total hotel costsfor all participants for all nights(e)
€ / Total travel costs for all participants(f)
€ / Total subsistence costs for all participantsfor all nights(g)
€ / Total cost of mission for all participants per mission
(e) + (f) +(g)
-
-
TOTAL Category

A.3 Costs of purchase of new equipment (depreciation only)[11]

Please note that only specific equipment directly related to the project will be considered under this category- general office equipment is to be included within the indirect costs category

Type of equipment / Date purchased or planned to / Purchase cost
€ / Method of calculation of depreciation / Eligible cost to action
€
TOTAL Category

A.4 Consumables and materials specific to the proposed ACTIVITIES (if not included in indirect costs).

Nature of costs (a) / Quantity (b) / Unit cost (c)
€ / TOTAL
(b x c) €
TOTAL Category

A.5 Sub-contracting costs

Subcontracting organisation (if already selected) / Justification for selection (if already selected) / Precise nature of task(s) sub-contracted / Procurement procedure followed / Total Costs €
TOTAL Category

A.6 Indirect (overhead) costs[12]to a maximum amount of 7% of the total eligible DIRECT COSTS

Description of costs / Costs / % of total project costs
TOTAL Category

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4.Other sources of external finance, excluding any

Community grant

(In the case of a partnership each partner should complete this form separately providing full details as to how the costs of their part of the project will be co-financed by external organisations, if applicable. The partners name should figure clearly at the top of this page)

The data below are to be provided for each external sponsor of the action.
4.1 Funds confirmed
A letter committing the financial contribution must be signed by each sponsor and included with the application.
(Add further sheets if necessary.)

• Official name in full:
• Official legal form:
• Official address
• Activities:
• Registration n° of organisation on business register

• Person responsible within the sponsoring organisation that has signed the commitment letter (name/first name, title or position):

• Amount of funding which the organisation undertakes to provide for the operation:
• Any conditions or reservations:

4.2 Other funds requested, being applied for or awaiting confirmation
(Add further sheets if necessary.)

• Organisation concerned:
• Official address:
• Activities:
• Amount requested:

Any conditions or reservations:

5. Declaration by the applicant

(To be completed and signed by the responsible person named at point 1.1 of this application)

I, the undersigned, (name)….., authorised representative, hereby request from the Parliament a grant of EUR (amount)…. ..with a view to implementing the action described in this proposal on the terms laid down in this application.
I certify that the information contained in this application is correct and that the applicant organisation has not received or applied for any other Community funding to carry out the actionwhich is the subject of this grant application.
I certify on my honour that the applicant organisation is not in one of the situations which would exclude it from taking part in a Community grant programme and accordingly declare that the organisation:
-is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors or suspended business activities, and is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
-has not been convicted of an offence concerning its professional conduct by a judgment which has the force of res judicata;
-is not guilty of grave professional misconduct proven by any means which the contracting authority can justify;
-has met its obligations relating to the payment of social security contributions or taxes under the legislation of the country in which it is established;
-has not been the subject of a judgment which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the Communities' financial interests;
-has not been declared to be in serious breach of contract for failure to comply with its contractual obligations subsequent to another procurement procedure or grant award procedure financed by the Community budget.
I have been informed that, under the Financial Regulation of 25 June2002 applicable to the general budget of the European Communities[13], applicants found guilty of false declarations may be subject to administrative and financial penalties in accordance with the conditions laid down in that Regulation.
The administrative penalties consist in being excluded from all contracts or grants financed from the Community budget for a maximum of two years from the date on which the infringement is established, as confirmed after an adversarial procedure with the applicant. This period may be extended to three years in the event of a repeat offence within five years of the first infringement. Applicants who are guilty of making false declarations will also receive financial penalties representing 2% to 10% of the value of the grant being awarded. This rate may be increased to 4% to 20% in the event of a repeat offence within five years of the first infringement.
Name / first name:
Signature and official stamp of applicant:
Date:
Your grant application will be processed by computer. All personal data (such as names, addresses, CVs, etc.) will be processed in accordance with Regulation (EC) No 45/2001 of the European Parliament and of the Council of 18December2000 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.[14] Your replies to the questions in this form are necessary in order to assess your grant application and they will be processed solely for that purpose by the department responsible for the Community grant programme concerned. On request, you may be sent personal data and correct or complete them. For any question relating to these data, please contact the Parliament department to which the form must be returned. Beneficiaries may lodge a complaint against the processing of their personal data with the European Data Protection Supervisor at any time.

PARTNERSHIP FORM

(If the proposal is introduced by a partnership of organisations, one version of this form should be completed and signed by each partner. It is not necessary for the applicant introducing the proposal to complete this form as all necessary information will be included in the main part of the application).

Name of Partner organisation: ......

Total estimated expenditure for your part of the project implementation:......

(This must correspond with your organisations version of the estimated budget at point 3.1 of the application form).

Total contribution from own resources towards the project costs (if applicable):......

Total amount of the European Parliaments grant that you expect to receive, by transfer from the applicant, towards your own costs incurred:......

Amount of expected funding from other sources towards your own costs:......

(This amount must correspond to the information that you have provided at point 4 of the application form).

I ...... (insert name), ...... (state function within organisation) of...... (insert name of organisation), hereby confirm that I agree to enter into partnership, for the sake of implementing the project being proposed in this application, and that the information contained in this application concerning this organisation is correct.

Signature & date:

Supporting documentation to be attached to the request for a grant

Documents to attach systematically to the request for a grant
(1)Duly completed application form and signed Declaration by representative from the applicant organisation. (All incomplete requests will be systematically rejected).
(2)Official annual accounts of the applicant (or annual budget if public authority) of the previous closed accounting period - these must be the officially registered accounts.
(3)Official statute and certificate of legal registration (unless the applicant is a public authority in which case this is not required)
(4)Curriculum vitae of the key personnel who will complete the tasks connected to the project to be subsidised.
(5)Annual activity report of the applicant organisation for the previous year or detailed description of main activities at point 1.3 of this form.
(6)Duly signed letters of commitment from co-funding organisations clearly stating the amount of co-financing or comments as to when the co-funding will be decided.
(7)Letter of guarantee of broadcasting if application is made to the Television or Radio category (category numbers 1 & 2)
(8)Duly completed and signed Partnership form(s) (if applicable)
(9)Please complete, clearly, the summary form on the last page (below) of this application form.DG Communication will notify receipt of applications and notification of reference number of proposals, by e-mail only, to the contact person named at point 1.1 (contact person) of this application form.

SUMMARY INFORMATION