EUROPEAN COMMISSIONDIRECTORATE-GENERALHUMANITARIAN AID AND CIVIL PROTECTION

GRANT APPLICATION FORMS

2014 CALL FOR PROPOSALS

FOR UNION CIVIL PROTECTION MECHANISM

EXERCISES

FORMS A and TNOTE:

Financial Forms are in a separate file.

FORMS A:Summary and Administrative

Information

Form A1

EUROPEAN COMMISSIONDG ECHO

FOR COMMISSION USE ONLY

Proposal n°

PROJECT

Project title (max. 60 characters):

……………………………………………………………………………………….............................................

..............................................................................................................

Project acronym (max. 25 characters):

………………………………………………………………………………..

The project will be implemented in the following country(ies):

………………………………………………………………………………………………….

………………………………………………………………………………………………………………………

………….

Starting date: ...................... Ending date: .......................... Duration in months (max 24): ……………

COORDINATOR AND BENEFICIARIES

Name of coordinator (CO): ...............................................................................................................

Name of beneficiary (AB1): …………………………………………………………………………………

Name of beneficiary (AB2): …………………………………………………………………………………

Name of beneficiary (AB3): …………………………………………………………………………………

(Continue as necessary)

PROJECT BUDGET AND REQUESTED EC FUNDING

Internal budget item External budget item

Total project eligible cost: ……………. EUR

EC financial contribution requested: ……………. EUR ( = …….. % of total eligible costs)

Form A2

V. DECLARATION OF HONOUR BY THE APPLICANT

The undersigned [insert name of the signatory of this form]: in [his][her] own name [for a natural person]

or representing the following legal person: [only if the applicant is a legal person]full official name:official legal form:full official address:VAT registration number:

authorised to represent the consortium, hereby requests from the Commission a grant of EUR …….. with a view to implementing the action on the terms laid down in this application.

I certify that the information contained in this application is correct and complete and that none of the applicants has received any other Union funding to carry out the action that is the subject of this grant application.

I certify that the applicants are not in one of the situations which would exclude them from receiving Union grants and accordingly

declare that none of the applicants:

a) is bankrupt or being wound up, is having its affairs administered by the courts, has entered into an arrangement with creditors, has suspended business activities, is the subject of proceedings concerning those matters, or is in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

b) has been convicted of an offence concerning professional conduct by a judgment of a competent authority of a Member State which has the force of res judicata;

c) has been guilty of grave professional misconduct proven by any means which the [Commission] [agency] can justify including by decisions of the European Investment Bank and international organisations;

d) is not in compliance with all its obligations relating to the payment of social security contributions and the payment of taxes in accordance with the legal provisions of the country in which it is established, with those of the country of the authorising officer responsible and those of the country where the [action] [work programme] is to be implemented;

e) has been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation, money laundering or any other illegal activity, where such activity is detrimental to the Union's financial interests;

f) is subject to an administrative penalty.

[[Only for legal persons other than Member States and local authorities, otherwise delete] declare that the natural persons with power of representation, decision-making or control1 over one of the applicants that are legal entities are not in the situations referred to in b) and e) above; ]

declare that the applicants:

g) have no conflict of interests in connection with the grant; a conflict of interests could arise in particular as a result of economic interests, political or national affinity, family, emotional life or any other shared interest;

h) will inform the Commission, without delay, of any situation considered a conflict of interests or which could give rise to a conflict of interests;

i) have not granted and will not grant, have not sought and will not seek, have not attempted and will not attempt to obtain, and have not accepted and will not accept any advantage, financial or in kind, to or from any party whatsoever, where such advantage constitutes an illegal practice or involves corruption, either directly or indirectly, inasmuch as it is an incentive or reward relating to the award of the grant;

j) provided accurate, sincere and complete information within the context of this grant award procedure.

In case of award of grant, the following evidence shall be provided upon request and within the time limit set by the Commission2: For situations described in (a), (b) and (e), production of a recent extract from the judicial

record is required or, failing that, a recent equivalent document issued by a judicial or administrative authority in the country of origin or provenance showing that those requirements are satisfied. Where the applicant is a legal person and the national legislation of the country in which the applicant is established does not allow the provision of such documents for legal persons, the documents should be provided for natural persons, such as the company directors or any person with powers of representation, decision making or control in relation to the applicant .

For the situation described in point (d) above, recent certificates or letters issued by the competent authorities of the State concerned are required. These documents must provide evidence covering all taxes and social security contributions for which the applicant is liable, including for example, VAT, income tax (natural persons only), company tax (legal persons only) and social security contributions.For any of the situations (a), (b), (d) or (e), where any document described in the two paragraphs above is not issued in the country concerned, it may be replaced by a sworn or, failing that, a solemn statement made by the interested party before a judicial or administrative authority, a notary or a qualified professional body in his country of origin or provenance.If the applicant is a legal person, information on the natural persons with power of representation, decision making or control over the legal person shall be provided only upon request by the Commission.

I declare that the applicants are fully eligible in accordance with the criteria set out in the specific call for proposals.

I certify that the applicants have the financial and operational capacity to carry out the proposed action.

I acknowledge that according to Article 131 of the Financial Regulation of 25 October 2012 on the financial rules applicable to the general budget of the Union (Official Journal L 298 of 26.10.2012, p. 1) and Article 145 of its Rules of Application (Official Journal L 362, 31.12.2012,

1 This covers the company directors, members of the management or supervisory bodies, and cases where one natural person holds a majority of shares.

2 In accordance with art.197 RAP, the RAO may, depending on a risk assessment, request that successful applicants provide the evidence of their complying with the exclusion criteria.

p.1) applicants found guilty of misrepresentation may be subject to administrative and financial penalties under certain conditions.

If selected to be awarded a grant, the applicants accept the general conditions as laid down in the grant [agreement] [decision publicly available].

Last name, first name:

Title or position in the consortium:

Signature [and official stamp] of the applicant:

Date:

Your reply to the grant application will involve the recording and processing of personal data (such as your name, address and CV), which will be processed pursuant to Regulation (EC) No 45/2001 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. Unless indicated otherwise, your replies to the questions in this form and any personal data requested are required to assess your grant application in accordance with the specifications of the call for proposals and will be processed solely for that purpose by the Commission. Details concerning the processing of your personal data are available on the privacy statement at the page: http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf.

Your personal data may be registered in the Early Warning System (EWS) only or both in the EWS and Central Exclusion Database (CED) by the Accounting Officer of the Commission, should you be in one of the situations mentioned in:- the Commission Decision 2008/969 of 16.12.2008 on the Early Warning System (for more information

see the Privacy Statement on http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm), or

- the Commission Regulation 2008/1302 of 17.12.2008 on the Central Exclusion Database (for more information see the Privacy Statement onhttp://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE )

Form A3

Partnership statement (to be signed by all partners)

A partnership is a relationship of substance between two or more organisations involving shared responsibilities in undertaking the action funded by the Union. To ensure that the action runs smoothly, the Commission requires all partners to acknowledge this by agreeing to the principles of good partnership practice set out below.

1. All partners must have read the Grant Application Guide and the Grant Application Forms and understood the purposes and expected results of the Call for proposals and what their role in the action will be before the application is submitted to the Commission. They commit to comply with the relevant eligibility criteria, as defined in the call for proposals.

2. All partners must have read the standard Grant Agreement and understood what their respective obligations under the Grant Agreement will be if the grant is awarded. They authorise the lead applicant to sign the Grant Agreement with the Commission and represent them in all dealings with the Commission in the context of the action's implementation.

3. The applicant must consult with its partners regularly and keep them fully informed of the progress of the project.

4. All partners must receive copies of the reports - narrative and financial - made to the Commission.

5. Proposals for substantial changes to the action (e.g. activities, partners, etc.) should be agreed by the partners before being submitted to the Commission. Where no such agreement can be reached, the applicant must indicate this when submitting changes for approval to the Commission.

I have read and approved the contents of the proposal submitted to the Commission. I undertake to comply with the principles of good partnership practice.

Name

Organisation

Position

Title of the Project

Date and place

Signature

Form A4 COORDINATOR PROFILE

Coordinator Profile InformationShort Name Participant ref. COLegal information on the CoordinatorLegal Name Legal StatusVAT No Public

PrivateNatural person

Legal Registration NoRegistration Date

International organisation

Legal address of the CoordinatorStreet Name and No PO BoxPost Code Town/City

Country Code Country NameCoordinator contact person information (only if different to above)Title Function

Surname First NameDepartment / Service NameStreet Name and No PO BoxPost Code Town/CityCountryTelephone No Fax NoE-mail WebsiteCoordinator detailsNumber of employeesNumber of employees in department conducting projectIs Your Organisation independent (Yes or No)If No, please indicate legal name(s) of owner(s) who own 25 % or moreIs Your Organisation affiliated to any other participant(s) in the project? (Yes or No)If Yes, please indicate Participant Short Name(s) and character of affiliations(s)Brief description of the structure and the activities of the Coordinator

Form A5BENEFICIARY PROFILE (Complete for each Beneficiary)

Beneficiary Profile InformationShort Name Participant ref. AB…Legal information on the BeneficiaryLegal Name Legal StatusVAT No Public

PrivateNatural person

Legal Registration NoRegistration Date

International organisation

Legal address of the BeneficiaryStreet Name and No PO BoxPost Code Town/City

Country Code Country NameBeneficiary contact person information (only if different to above)Title Function

Surname First NameDepartment / Service NameStreet Name and No PO BoxPost Code Town/CityCountryTelephone No Fax NoE-mail WebsiteBeneficiary details

Annual turnover Last Financial YearNumber of employeesNumber of employees in department conducting projectIs Your Organisation independent (Yes or No)If No, please indicate legal name(s) of owner(s) who own 25 % or moreIs Your Organisation affiliated to any other participant(s) in the project? (Yes or No)If Yes, please indicate Participant Short Name(s) and character of affiliations(s)Brief description of the structure and the activities of the Beneficiary

Form A6CO-FINANCIER PROFILE AND COMMITMENT (Complete for each co-financier)

Legal Name and full address on the co-financier

Financial commitment

We will contribute the following amount to the project: ….. EUR

Status of the financial commitment

Stamp and signature of the authorised person

Name and status of the authorised person (obligatory):

Date of the signature(obligatory):

Signature (obligatory):

Form A7

OTHER PROPOSALS SUBMITTED FOR EUROPEAN UNION FUNDING

Please answer each of the following questions:

Have you or any of the beneficiaries already benefited from previous co-financing under any EU civil protection financial instruments or programmes? (Title, year, amount of the co-financing and duration)

Have you or any of the beneficiaries already benefited from previous European Union financing (grants, procurements or loans) for activities that may relate to the present proposal (e.g. an RTD project preceding the present proposal)? (title, year, amount of financing and duration)

Have you or any of the beneficiaries applied for European Union funding under any other financial instruments for actions which form part of or are directly related to this proposal? With what results? Please give full details!

Form A8

INVOLVEMENT OF THE COMPETENT NATIONAL CIVIL PROTECTION AUTHORITY/MARINE POLLUTION AUTHORITY

(for the coordinator/beneficiaries and the countries participating in the exercise by deploying intervention resources on the field)

Name: [name of the competent national civil protection authority/marine pollution authority][name of the department within the competent national civil protection authority/marine pollution authority]

Contact person: [name of the contact person in the competent national civil protection authority/marine pollution authority][position/rank in the competent national civil protection authority/marine pollution authority]

Full address: [street/P.O. Box][town][country][phone][Fax][E-mail]

Confirms that it has been informed about the following project proposal and its content:

[Project title:]

Lead by: [name of Coordinator’s organisation]

And declares that the competent national civil protection authority/marine pollution authority (please circle the answer that applies):

1) Supports the application of the above mentioned project YES / NO

2) Confirms it is consistent with national policies, plans and procedures YES / NO

3) Will participate in the project (please circle all that apply)

a) as Coordinator YES / NO

b) as Partner Organisation ( Beneficiary) YES / NO

4) Will participate as exercise player as required by the legal basis governing the national participation in the Community Civil Protection Mechanism (i.e. ensuring at minimum the participation of the declared 24/7 national operational contact point, etc) YES / NO

Person entitled to enter into commitments on behalf of the competent national civil protection authority/marine pollution authority

Name:

Status/title:

Signature

Date

Place

Form A9

Template of Legal Entities Form

The Legal Entity form specifically adapted to the legal status of the Coordinator (public entity or private company) as well as to the country/ language is available on

http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm

ATTENTION/ The document below is only an example. Please use the appropriate document available from the above link.

Form A10

Template of Financial Identification Form

The financial identification form specifically adapted to the country/ language of the bank account is available onhttp://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm

Form A11

EUROPEAN COMMISSIONDIRECTORATE-GENERAL HUMANITARIAN AID AND CIVIL PROTECTION - ECHO

ECHO B – Humanitarian and Civil Protection OperationsB/1 – Emergency Response

Brussels, DG ECHO, Unit B1

Name of Coordinator:

Contact person1:

Postal Address:

E-mail1:

ACKNOWLEDGEMENT OF RECEIPT

Title of the project1: ........Correspondence No. of the project:

Sir, Madam

I acknowledge receipt of your proposal for which I thank you.

Your proposal will be examined by our services, with respect to its eligibility. Those projects declared eligible will then undergo an evaluation procedure by the Commission.

I will let you know the final decision, as soon as it has been taken.

Yours faithfully,

Signature ECHO: .......................................................Form A12

1

1 1 To be completed by the Coordinator1

VAT DECLARATION APPLICABLE TO PUBLIC ENTITIES3 (To be completed by each Beneficiary)

The undersigned [LAST NAME, Name of the signatory of the declaration], on behalf of[Full official name of the entity][Official legal form of the entity][Full official address of the entity][VAT registration number of the entity]

declares that

the activities carried out in the frames of this project by this body governed by public law are activities or transactions in which the public law body engages as a public authority under national law, or

the activities carried out in the frames of this project by this body governed by public law are not activities or transactions in which the public law body engages as a public authority under national law.

Name:Status/Title:

Signature

Date

Place

3 The declaration is to be completed by bodies governed by public law, which declare cost with VAT included.

SECTION T:

Objective, actions and expected

resultsProject planning

and structure

Form T1

SUMMARY OF THE PROJECT (Maximum 3-4 pages)

Background

Scenario

Objectives

Expected results

Actions and means involved

Form T2

Project AcronymTask ID Task Title Start Date End Date Actions Deliverables

(Maximum number of tasks – 10)

Form T3a

Project Acronym T3a - Task Form

Task ID Task Title

Objectives

DESCRIPTION

Action A.1Name of the action:Description (what, how and where):Expected results:Constraints and assumptions:Responsible for implementing it:Action will be subcontracted: Yes/No/Partially

Action A.2Name of the action:Description (what, how and where):Expected results:Constraints and assumptions:Responsible for implementing it:Action will be subcontracted: Yes/No/Partially

Etc.

Form T3b

Project AcronymT3b- Task Form Page 1 of

maximum 10 (1 task per page)

Task ID Task Title

Start Date End Date Duration

Deliverable Date Deliverable Description

Form T4

CONTINUATION

Continuation after the project ends:

What still needs to be done (which actions will have to be continued or maintained)

How will this be achieved, which resources will be necessary to continue the actions?

How will the equipment acquired be used?

Which personnel will continue to work on the project?