Subject: information on the grants received de minimis[1]

Please complete this declaration of previous State aid[2] received under the de minimis rule. Using this information we will assess your eligibility to receive assistance. Please note that having received previous aid under the de minimis Regulation does not automatically disqualify you from receiving further de minimis aid from the Territorial Cooperation Programme.

Declaration

Project name, project number and acronym:

Participation in the above mentioned project entails aid for the SME of EUR:

Name of the SME:

Registration number of the SME:

Business sector[3]:

I, the undersigned, representing the above mentioned SME, declare that:

The institution I represent and all other entities belonging to the same company group as my institution have not received any contribution falling under the de minimis Regulation during the previous three fiscal years (this being the current fiscal year and the previous two fiscal years);

The institution I represent and all other entities belonging to the same company group as my institution have received the following contribution(s) falling under the de minimis Regulation during the previous three fiscal years (this being the current fiscal year and the previous two fiscal years):

Organisation providing
the state aid / Beneficiary / Country which granted
the state aid / Amount of the contribution in EUR / Date of granting
Total

I acknowledge that untruthful/false declarations, in addition to the administrative sanctions and the request for refunding unduly received contribution charged with the interests, can also be prosecuted.

______

Signature Date

______

Name and function of the person signing for the SME (and official stamp where applicable)

[1]Regulation (EC) No 1407/2013 of 18 December 2013 on the application of Articles 107 and 108 of the Treaty and the Functioning of the European Union to de minimis aid (the ‘de minimis regulation’), Article 3.

[2]State aid is given to the undertaking on a selective basis and does not include subsidies granted to individuals or general measures open to all enterprises. State aid can e.g. have the format of grants, interest and tax reliefs, guarantees, government holdings of all part of the company, or providing goods and services on preferential terms. Please indicate if the state aid has had any other format than grant.

[3]Please note that in relation to de minimis special rules apply for undertakings active in the fishery and aquaculture sector and primary production of agricultural products. Furthermore, specific rules apply for the road freight transport sector.SeeArticle 1 and 3 in the de minimis regulation.