WRITTEN EVIDENCE FOR LINKAGE INFRASTRUCTURE, EQUIPMENT AND FACILITIES (LIEF) FOR FUNDING COMMENCING IN 2019

(For evidence of agreement from Proposal Participants and Organisations)

LE19010xxxx / Lead CI name:

PART A – PARTICIPANTS

Certification by Chief/Partner Investigators (including lead CI)

I certify that:

i) I have Head of School/Department/Organisation support for this application;

ii) all the details on this Proposal are true and complete;

iii) proper inquiries have been made and I am satisfied that I meet the eligibility criteria as specified in the Funding Rules;

iv) I have complied with the Funding Rules,and if the Proposal is successful I agree to abide by the terms of theLinkage Infrastructure, Equipment and Facilities Funding Agreement for funding commencing in 2018;

v) I understand and agree that all statutory requirements must be met before the proposed research can commence;

vi) I have notified the Administering Organisation of any actual or potential conflicts of interest I may have in relation to the Proposal and I undertake that, if the Proposal is successful, I will notify the Administering Organisation of any conflicts of interest which arise subsequent to the submission of the Proposal; and

vii) I will notify the Administering Organisation if there are any changes in my circumstances which may impact on my eligibility to participate in, or ability to perform, the project subsequent to the submission of this Proposal;

In participating in this Proposal, I consent to:

i) this Proposal being referred under confidentiality conditions to third parties, who will remain anonymous, for evaluation or assessment purposes; and

ii) the ARC copying, modifying and otherwise dealing with information contained in the Proposal, for the purpose of conducting the funding round.

Please tick one:

Lead Chief Investigator / Chief Investigator / Partner Investigator
Name of Participant:
Name of Participant’s Organisation:
Participant’s signature:
Date:

PART B – PARTICIPATING ORGANISATIONS

Note: Part B must be completed.

Certification by Organisations contributing to the project

  • HoS, DVCR, CEO or delegate to certify and sign

I certify that:

i) my organisation supports the Proposal and will contribute the resources outlined in the Proposal and as per the below table; and

ii) I have complied with the Funding Rules,and if the Proposal is successful I agree to abide by the terms of the Linkage Infrastructure, Equipment and Facilities Funding Agreement for funding commencing in 2018.

Head of School/DVCR/CEO or delegate:

Full name:
Position:
Name of Organisation:
Signature:
Date:

Funding to be contributed by the organisation:

  • Table is to be completed by an authorised delegate of the organisation only

Year * / $ Cash / $ In-kind / $ Total
2019

*Add rows as required

Complete, sign and email form to asap, but no later than 28February2018.

Please ensure the email is entitled CERTIFICATION FORM LIEF19.