PADOR OFF-LINE FORM

THIS ANNEX MUST BE FILLED IN BY APPLICANTS/PARTNERS WHO REQUEST A DISPENDSATION (DEROGATION) FROM THE OBLIGATION TO REGISTER IN PADOR. ALL OTHER APPLICANTS/PARTNERS MUST ENCODE THIS INFORMATION IN PADOR. ( http://ec.europa.eu/europeaid/work/onlineservices/pador/index_en.htm)

Justification for the request for derogation from the obligation to register in PADOR:Annexed documents substantiating the request for derogation (if any):

1. IDENTITYName of the organisation:

Abbreviation

Organisation's e-mail

Address

Postal Code

P.O. Box

City

Country

Phone

Fax

WebsiteNational registration number:

Date of registration:

Place of registrationVAT number:

Make your profile public 1 Yes

No

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1 If you choose to make your profile public, it will become visible to other organisations via the 'search for partners' function of PADOR

Green fields are optional. Orange fields are mandatory.

Please use Adobe Acrobat Reader (free) version 9 or above.

2. PROFILE

Legal entityPublic bodies (including local authorities) / International Organisations

Private Law Body

Legal status

Profit-makingYes

No

NGOYes

No

Value basedPolitical

Religious

Humanistic

Neutral

Is your organisation linked to another entity? Yes,parent entity

please specify its EuropeAid ID:

Yes, controlled entity(ies)

Yes, family organisation / network entity 1

No, independent

1 E.g. confederation/federation/alliance.

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Category

2

Education Education, level unspecified

Education Policy & Admin. Management Education Facilities And Training Teacher Training Educational Research

Basic education Primary Education Basic life skills for youth and adults

2Please tick the box for each sector your organisation has been active in. The provided list is based on the official OECD DAC list.

11 111

11110 11120 11130 11182

112 11220 11230

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EU Member State

Public Administration Local authorityOther

Third Countries

Public Administration Local authorityOther

Commercial Companies / Organisations

Commercial Companies / OrganisationsInternational Organisations

United Nations FamilyRegional authoritiesOther

Universities and Research Institutes

University/Education Institute of research

Others

AssociationFoundation Think TankProfessional and/or Industrial Organisation Trade Union Other non-State actor

Secondary education Early childhood education

Secondary education Vocational Training

Post-secondary education Higher Education Advanced Tech. & Managerial Training

Health Health, general

Health Policy & Admin. Management Medical education/training Medical Research Medical Services

Basic health Basic Health Care Basic Health Infrastructure Basic Nutrition Infectious Disease Control Health Education Health Personnel Development

Population programmes Population polices/programs and reproductive health

Population Policy And Admin. Mgmt Reproductive Health Care Family planning Std Control Including HIV/Aids Personnel development for population & reproductive health

Water Supply and Sanitation Water supply and sanitation

Water Resources Policy/Admin. Mgmt Water Resources Protection Water supply & sanitation - Large systems Basic drinking water supply & basic sanitation River Development Waste Management/Disposal Education & training in water supply and sanitation

Government and Civil Society Government and civil society, general

Economic and development policy/planning Public sector financial management Legal and judicial development Government administration Strengthening civil society Elections Human Rights Free Flow Of Information Women's equality organisations and institutions

Conflict prevention an resolution, peace and security Security system management and reform Civilian peace-building, conflict prevention and resolution Post-conflict peace-building (UN) Reintegration and SALW control

11420 114

11330 11320

113 11240

12182 12181 12110

121 12

11430

12250 12240 12230 12220

122 12191

13020 13010

130 13

12281 12261

14010 140

14 13081 13040 13030

14081 14050 14040 14030 14020 14015

15140 15130 15120 15110

151 15

152 15164 15163 15162 15161 15150

15210 15220 15230 15240

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Banking and financial services

15250 15261

16 16010 16020 16030 16040 16050 16061 16062 16063 16064

21 210

21010 21020 21030 21040 21050 21061 21081

22 220

22010 22020 22030 22040

23 230

23010 23020 23030 23040 23050 23061 23062 23063 23064 23065 23066 23067 23068 23069 23070 23081 23082

24 240

24010 24020 24030 24040

Land mine clearance Child soldiers (prevention and demobilisation)

Other Social Infrastructure and Service Social/welfare services Employment policy and admin. mgmt. Housing policy and admin. management Low-cost housing Multisector aid for basic social services Culture and recreation Statistical capacity building Narcotics control Social mitigation of HIV/AIDS

Transport and Storage Transport and storage

Transport Policy & Admin. Management Road Transport Rail Transport Water Transport Air Transport Storage Education & Training In Transport & Storage

Communications Communications

Communications Policy & Admin. Mgmt Telecommunications Radio/Television/Print Media Information and communication technology (ICT)

Energy Energy generation and supply

Energy Policy And Admin. Management Power Generation/Non-Renewable Sources Power Generation/Renewable Sources Electrical Transmission/Distribution Gas distribution Oil-Fired Power Plants Gas-Fired Power Plants Coal-Fired Power Plants Nuclear Power Plants Hydro-electric Power Plants Geothermal energy Solar energy Wind power Ocean power Biomass Energy education/training Energy research

Banking and Financial Services

Financial Policy & Admin. Management Monetary institutions Formal Sector Financial Institutions Informal/Semi-Formal Financial intermediaries

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24081 25

250 25010 25020

31 311

31110 31120 31130 31140 31150 31161 31162 31163 31164 31165 31166 31181 31182 31191 31192 31193 31194 31195

312 31210 31220 31261 31281 31282 31291

313 31310 31320 31381 31382 31391

32 321

32110 32120 32130 32140 32161 32162 32163 32164 32165 32166 32167 32168

Education/trng in banking & fin. services Business and Other Services

Business and other services Business support services and institutions Privatisation

Agriculture, Forestry and Fishing Agriculture

Agricultural Policy And Admin. Mgmt Agricultural development Agricultural Land Resources Agricultural Water Resources Agricultural inputs Food Crop Production Industrial Crops/Export Crops Livestock Agrarian reform Agricultural alternative development Agricultural extension Agricultural Education/Training Agricultural Research Agricultural services Plant and post-harvest protection and pest control Agricultural financial services Agricultural co-operatives Livestock/Veterinary Services

Forestry Forestry Policy & Admin. Management Forestry development Fuel wood/charcoal Forestry education/training Forestry research

Fishing Fishing Policy And Admin. Management Fishery development Fishery education/training Fishery research Fishery services

Industry, Mining and Construction Industry

Industrial Policy And Admin. Mgmt Industrial development Small and medium-sized enterprises (SME) development Cottage industries and handicraft Agro-Industries Forest industries Textiles - leather & substitutes Chemicals Fertilizer plants Cement/lime/plaster Energy manufacturing Pharmaceutical production

Forestry services

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32169 32170 32171 32172 32182

322 32210 32220 32261 32262 32263 32264 32265 32266 32267 32268

323 32310

33 331

33110 33120 33130 33140 33181

332 33210

41 410

41010 41020 41030 41040 41050 41081 41082

43 430

43010 43030 43040 43050 43081 43082

51 510

51010 52

520 52010

53 530

Basic metal industries Non-ferrous metal industries Engineering Transport equipment industry Technological research and development

Mineral resources and mining Mineral/Mining Policy & Admin. Mgmt Mineral Prospection And Exploration Coal Oil and gas Ferrous metals Non-ferrous metals Precious metals/materials Industrial minerals Fertilizer minerals Offshore minerals

Construction Construction Policy And Admin. Mgmt

Trade and Tourism Trade policy and regulation

Trade Policy And Admin. Management Trade facilitation Regional trade agreements (RTAs) Multilateral trade negotiation Trade education & training

Tourism Tourism Policy And Admin. Management

General Environment Protection General environmental protection

Environmental Policy And Admin. Mgmt Biosphere protection Bio-diversity Site Preservation Flood Prevention/Control Environmental education/training Environmental research

Other multisector Other multisector

Multisector Aid Urban Development And Management Rural Development Non-agricultural alternative development Multisector education/training Research/scientific institutions

General budget support General budget support

General budget support Development food aid/food security

Development food aid/food security assistance Food Aid / Food Security Programmes

Other commodity assistance Other commodity assistance

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53030 53040

60 600

60010 60020 60030 60040 60061 60062 60063

72 720

72010 72030

72050 73

730 73010

74 740

74010 91

910 91010

92 920

92010 92020 92030

93 930

93010 99

998 99810 99820

70

72040

700

Import support (capital goods) Import support (commodities)

Action relating to debt Action relating to debt

Action relating to debt Debt forgiveness Relief of multilateral debt Rescheduling and refinancing Debt for development swap Other debt swap Debt buy-back

Emergency response Emergency response

Material relief assistance and services Aid to refugees (In Recipient Country)

Relief coordination; protection and support services Reconstruction relief and rehabilitation

Reconstruction relief and rehabilitation Reconstruction relief and rehabilitation

Disaster prevention and preparedness Disaster prevention and preparedness

Disaster prevention and preparedness Administrative costs of donors

Administrative costs of donors Administrative Costs

Support to NGO Support to NGO

Support to national NGOs Support to international NGOs Support to local and regional NGOs

Refugees Refugees (in donor countries) Refugees (in donor countries)

Unallocated/unspecified Unallocated/unspecified

Sectors Not Specified Promotion of Development Awareness

Emergency food aid

Humanitarian AidHumanitarian Aid

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AllChild soldiers Community Based Organisation(s) ConsumersDisabled Drug consumers Educational organisations (school, universities)Elderly people Illness affected people (Malaria, Tuberculosis, HIV/AIDS)Indigenous peoples Local authorities Non Governmental Organisations Prisoners Professional category Refugees and displaced Research organisations/Researchers SME/SMI Students Urban slum dwellers Victims of conflicts/catastrophes Women Young people Other (please specify):

Sector Year(s) of Experience Number of Projects Estimated Amount (in Euros)

3. CAPACITY TO MANAGE AND IMPLEMENT ACTIONS

3.1. Experience by Sector (for each sector selected in 2.2.)

3.2. Experience by Geographical area (country or region)

Geographical area (country or region) Year(s) of Experience Number of Projects Estimated Amount (in Euros)

Indicative list of regions

− Asia -Central Asia Region -Eastern Asia Region -South Asia Region -South East Asia Region − Caribbean Region − EU Europe − Europe apart from EU -Eastern Europe Region − Latin American Countries -Central American Region -South America Region − Near and Middle East -Eastern Europe Region -Gulf States -Mediterranean Region − North America Countries − Overseas countries and territories − Pacific Region

− Sub-Saharan Africa -Central Africa Region -East Africa Region -Indian Ocean Region -Southern Africa Region

-West Africa Region

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3.3. Resources

The data registered in this section must be in-line with the financial report submitted, and can be further explained under the Additional information section. If some or all these indicators are not relevant to your organisation, please type ''0''. It is necessary to provide your financial data for the past three years for which data is available.

3.3.1. Financial data (amounts in EUR).

3.3.2. Financing Source(s) (please tick the source(s) of the revenues of your organisation and specify the additional information requested)

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Year Turnover or equivalent

Net earnings or equivalent

Total sheet or budget balance

Shareholders’ equity or

equivalent

Medium and long-term debt

Short-term debt (< 1 year)

Year SourcesPercentage (total for a given year must be

equal to 100%)

Total 100%

Please note that applicants (except public law bodies and international organisations) requesting a grant of more than EUR 750 000.00 (EUR 100 000 for operating grant) must provide an audit report (ref. point 2.4 of the Guidelines for grant applicants).

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Year Sources Percentage (total for a given year must be

equal to 100%)

Total 100%

Total 100%

From to

From to

From to

3.3.3. Number of staff (full-time equivalent) (please tick one option for each type of staff):

4. LIST OF THE MANAGEMENT BOARD/COMMITTEE OF YOUR ORGANISATION

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Type of staff Paid Unpaid

HQ Staff: recruited and based in Headquarters (located in Developed Country)

Expat Staff: recruited in Headquarters (located in Developed Country) and based in Developing Country

Local staff: recruited and based in Developing Country

Percentage Female / Male total paid staff

Female Male

Title Name Profession Function Country of Nationality On the board since

5. SUPPORTING DOCUMENT CHECK LIST

6. ADDITIONAL INFORMATION ( NOT OBLIGATORY )

To be developed in 20.000 maximum characters (you may cut and paste unformatted text): Strategies/methodologies/philosophies and approaches of your organisation - How do you choose a country/region, a project, a partner - Conditions to create a strong partnership, ownership, «participatory approach », …

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Please ensure that the following documents will be submitted together with this form: