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Grant Application Form

Contracting Authority: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH

Eastern Partnership Territorial Cooperation Programmes
Tettitorial Cooperation Programme Azerbaijan - Georgia

Reference: 1st call for proposals

Deadline for submission of concept notes and applications: 17 December 2015


Please note! The e-training is a practical tool to virtually guide the potential applicants through the application process available for the training purposes only.

In no way should it be considered as a full-fledge application that has to be submitted to the EaPTC Managing Authority according to the established procedure.

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Title of the action
Location(s) of the action
Name of the applicant
Nationality of the applicant ?An organisation’s statutes must show that it was established under the national law of the country concerned and that the head office is located in an eligible country. Any organisation established in a different country cannot be considered an eligible local organisation. See the footnotes to the Guidelines for the call.
EuropeAid ID ?To be inserted if the organisation is registered in PADOR (Potential Applicant Data On-Line Registration). For more information and to register, please visit http://ec.europa.eu/europeaid/onlineservices/pador.
Ongoing contract/Legal Entity File Number ?If an applicant has already signed a contract with the European Commission and/or has been informed of the Legal Entity File number. If not, write ‘N/A’.
Legal status ?E.g. non-profit, governmental body, international organisation.
Co-applicant ?Use one row for each co-applicant
Affiliated entity ?Use one row for each affiliated entity

Applicant’s contact details for the purpose of this action

Postal address
Telephone number: (fixed and mobile)
Fax number
Contact person for this action
Contact person’s email
Address
Website of the Organisation
Any change in the addresses, phone numbers, fax numbers or e-mail, must be notified in writing to the Contracting Authority. The Contracting Authority will not be held responsible in the event that it cannot contact an applicant.


Part A. CONCEPT NOTE



1 Instructions for drafting the concept note

Please note that if this is a restricted call, only the concept note should be submitted in the first stage (no full application). If this is an open call, both the concept note and the full application shall be submitted at the same time.

There is no specific template for the Concept Note but the applicant must ensure that the text:

  • does not exceed 5 full pages (A4 size) of Arial 10 characters with 2 cm margins, single line spacing;
  • provides the information requested under the headings below, in the order in which it is requested, and in proportion to its relative importance (see the relevant scores set out in the evaluation grid and in the Guidelines);
  • provides full information (as the evaluation grid will be applied solely on the information in the concept note);
  • is drafted as clearly as possible to enable it to be evaluated.

1.1. Summary of the action ?Cover page as per template in page 1 should be attached as well

Please complete the table below, which should not exceed 1 page.

Title of the action
Location of the action
Total duration of the action months
EU financing requested (amount)
EU financing requested as a percentage of total budget of the Action (indicative) %
Overall objective(s) of the action
Specific objective(s) of the action
Target group(s) ?“Target groups” are the groups/entities who will directly benefit from the action at the action purpose level.
Final beneficiaries ?“Final beneficiaries” are those who will benefit from the action in the long term at the level of the society or sector at large.
Estimated results
Main activities

1.2. Description of the action (max 1 page)

Please provide all the following information:

  • Give the background to the preparation of the action.
  • Explain the objectives of the action given in the table in Section 1.1.
  • Describe the key stakeholder groups, their attitudes towards the action and any consultations held with them.
  • Briefly state the type of activities proposed and specify related outputs and results, including a description of linkages/relationships between activity clusters.
  • State the broad timeframe for the action and describe any specific factor that has been taken into account.

1.3. Relevance of the action (max 3 pages)

1.3.1. Relevance to the objectives/sectors/themes/specific priorities of the call for proposals

Please provide all the following information:

  • Describe the relevance of the action to the objective(s) and priority (ies) of the call for proposals.
  • Describe the relevance of the action to any specific subthemes/sectors/areas and any other specific requirements stated in the Guidelines for the call, e.g. local ownership etc.
  • Describe which particular expected results referred to in the Guidelines for the call will be addressed.

1.3.2. Relevance to the particular needs and constraints of the target country/countries, region(s) and/or relevant sectors (including synergy with other EU initiatives and avoidance of duplication)

Please provide all the following information:

  • State clearly the specific pre-project situation in the target country/countries, region(s) and/or sectors (include quantified data analysis where possible).
  • Provide a detailed analysis of the problems to be addressed by the action and how they are interrelated at all levels.
  • Refer to any significant plans undertaken at national, regional and/or local level relevant to the action and describe how the action will relate to such plans.
  • Where the action is the continuation of a previous action, clearly indicate how it is intended to build on the activities/results of this previous action; refer to the main conclusions and recommendations of any evaluations carried out.
  • Where the action is part of a larger programme, clearly explain how it fits or is coordinated with that programme or any other planned project. Specify the potential synergies with other initiatives, in particular by the European Commission.

1.3.3. Describe and define the target groups and final beneficiaries, their needs and constraints, and state how the action will address these needs

Please provide all the following information:

  • Give a description of each of the target groups and final beneficiaries (quantified where possible), including selection criteria.
  • Identify the needs and constraints of each of the target groups and final beneficiaries.
  • Demonstrate the relevance of the proposal to the needs and constraints of the target groups and final beneficiaries.
  • Explain any participatory process ensuring participation by the target groups and final beneficiaries.

1.3.4. Cross-border impact

Indicate how the proposal demonstrates the cross-border character by describing how at least one of the following criteria is applied in the action: joint development, joint staffing, joint implementation and/or joint financing.



Part B. Full Application Form

To be submitted by all applicants
To reduce expense and waste, we strongly recommend that you use only paper for your file (no plastic folders or dividers). Please also use double-sided printing if possible



1 General information

Reference of the Call for Proposals
Title of the Call for Proposals
Name of the applicant
Number of the proposal ?For restricted procedures only; when the Contracting Authority has evaluated the Concept Note it informs the applicant of the outcome and allocates a proposal number.
Title of the action
Location of the action


2 The action ?The evaluation committee will refer to information provided in the Concept Note as regards objectives and the relevance of the action.

2.1. Description of the Action

2.1.1. Description (max 13 pages)

Provide a description of the proposed action, including all the information requested below, referring to the overall objective(s) and specific objective(s), outputs and results described in the concept note:

  • Explain the specific results expected, stating how the action will improve the situation of the target groups and final beneficiaries and the technical and management capacities of target groups and/or any local co-applicants and affiliated entity(ies).
  • Identify and describe in detail each activity (or work package) to be undertaken to produce results, justifying the choice of activities and specifying the role of each co-applicant(s) and affiliated entity(ies) (and associates or contractors or sub-grantees where applicable) in the activities. Do not repeat the action plan to be provided in Section 2.1.3, but demonstrate coherence and consistency of project design. In particular, list any publications proposed.
  • If financial support is allowed by the Guidelines for Applicants, applicants wishing to give financial support to third parties must define, in line with the conditions set by the Guidelines for Applicants, the objectives and results to be obtained with financial support, the different types of activities eligible for financial support, on the basis of a fixed list, the types of entity eligible or categories of persons which may receive financial support, the criteria for selecting these entities and giving the financial support, the criteria for determining the exact amount of financial support for each third entity, and the maximum amount which may be given.

2.1.2. Methodology (max 5 pages)

Describe in detail:

  • the methods of implementation and rationale for such methodology;
  • where the action continues a previous action, describe how the action is intended to build on the results of the previous action (give the main conclusions and recommendations of any evaluations carried out);
  • where the action is part of a larger programme, explain how it fits or is coordinated with this programme or any other possibly planned project (please specify potential synergies with other initiatives, in particular by the European Union);
  • the procedures for follow up and internal/external evaluation;
  • the role and participation in the action of the various actors and stakeholders (co-applicant(s), affiliated entity(ies), target groups, local authorities, etc.), and the reasons why these roles have been assigned to them;
  • the organisational structure and the team proposed for the implementation of the action (by function: there is no need to include the names of individuals);
  • the main means proposed for the implementation of the action (equipment, materials, and supplies to be acquired or rented);
  • the attitudes of all stakeholders towards the action in general and the activities in particular;
  • the planned activities in order to ensure the visibility of the action and the EU funding.

2.1.3. Duration and indicative action plan for implementing the action (max 4 pages)

The duration of the action will be <X> months.

Applicants should not give a specific start-up date for the implementation of the action but simply refer to ‘month 1’, ‘month 2’, etc.

Applicants are recommended to base the estimated duration of each activity and the total period on the most probable duration and not on the shortest possible duration, by taking into consideration all relevant factors that may affect the implementation timetable.

The activities stated in the action plan should match those described in detail in Section 2.1.1. The implementing body must be either the applicants or any of the affiliated entity(ies), associates or subcontractors. Any months or interim periods without activities must be included in the action plan and count toward the calculation of the total estimated duration of the action.

The action plan for the first 12 months of implementation should be sufficiently detailed to give an overview of the preparation and implementation of each activity. The action plan for each of the subsequent years may be more general and should only list the main activities proposed for those years. To this end, it must be divided into six-month periods (NB: A more detailed action plan for each subsequent year must be submitted before any new pre-financing payments are received under Article 4.1 of the Special Conditions of the grant contract).

The action plan will be drawn up using the following format:

Month Half-year
Activity 1 2 3 4 5 6 7 8 9 10 11 12 3 4 5 6 7 8 9 10 Implementing body
1 Preparation
Execution

2.1.4. Sustainability of the action (max 3 pages)

Provide all the information requested below:

  • Describe the expected impact of the action with quantified data where possible, at technical, economic, social, and policy levels (will it lead to improved legislation, codes of conduct, methods, etc.?).
  • Describe a dissemination plan and the possibilities for replication and extension of the action outcomes (multiplier effects), clearly indicating any intended dissemination channel.
  • Provide a detailed risk analysis and contingency plan. This should include a list of risks associated with each proposed action, accompanied by relevant mitigation measures. A good risk analysis will include a range of risk types including physical, environmental, political, economic and social risks.
  • Describe the main preconditions and assumptions during and after the implementation phase.
  • Explain how the action will be made sustainable after completion. This may include necessary follow-up activities, built-in strategies, ownership, communication plan, etc. Distinguish between four types of sustainability:
    a. Financial sustainability: e.g. financing of follow-up activities, sources of revenue for covering all future operating and maintenance costs.
    b. Institutional sustainability: e.g. structures that would allow the results of the action to continue to be in place after the end of the action, capacity building, agreements and local ‘ownership’ of action outcomes.
    c. Policy level sustainability: e.g., where applicable, structural impact (improved legislation, consistency with existing frameworks, codes of conduct, or methods).
    d. Environmental sustainability: what impact will the action have on the environment — have conditions been put in place to avoid negative effects on the natural resources on which the action depends and on the broader natural environment?

2.1.5. Logical Framework

Please fill in Annex C to the Guidelines for Applicants.


2.1.6. Budget, amount requested from the Contracting Authority and other expected sources of funding

Fill in Annex B to the Guidelines for Applicants to provide information on:

  • the budget of the action (worksheet 1), for the total duration of the action and for its first <12/if more specify> months;
  • justification of the budget (worksheet 2), for the total duration of the action, and
  • amount requested from the Contracting Authority and other expected sources of funding for the action for the total duration (worksheet 3).

For further information, see the Guidelines for Grant Applicants.

Please note that the cost of the action and the contribution requested from the Contracting Authority must be stated in EURO.

2.2.1. Applicant’s experience

This information will be used to assess whether you have sufficient and stable experience of managing actions in the same sector and of a comparable scale to the one for which a grant is being requested.

i) For similar actions.

Please provide a detailed description of actions in the same sector and of a comparable scale to the one for which a grant is being requested managed by your organisation in the past three years.

Maximum 1 page per action.

Name of the applicant
Project title
Location of the action Cost of the action (EUR) Role in the action Donors to the action (name) ?If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Amount contributed (by donor) Dates

Objectives and results of the action

ii) Other actions

Please provide a detailed description of other actions managed by your organisation in the past three years.

Maximum 1 page per action and maximum 10 actions.

Name of the applicant
Project title
Location of the action Cost of the action (EUR) Role in the action Donors to the action (name) ?If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Amount contributed (by donor) Dates

Objectives and results of the action

2.2.2. Co-applicant(s)'s experience (if applicable)

This information will be used to assess whether you have sufficient and stable experience of managing actions in the same sector and of a comparable scale to the one for which a grant is being requested.

i) For similar actions.

Please provide a detailed description of actions in the same sector and of a comparable scale to the one for which a grant is being requested managed by your organisation in the past three years.

Maximum 1 page per action.

Name of the co-applicant
Project title
Location of the action Cost of the action (EUR) Role in the action Donors to the action (name) ?If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Amount contributed (by donor) Dates

Objectives and results of the action

ii) Other actions

Please provide a detailed description of other actions managed by your organisation in the past three years.

Maximum 1 page per action and maximum 10 actions.

Name of the co-applicant
Project title
Location of the action Cost of the action (EUR) Role in the action Donors to the action (name) ?If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Amount contributed (by donor) Dates

Objectives and results of the action

2.3. Affiliated entity(ies) experience (if applicable)

This information will be used to assess whether you have sufficient and stable experience of managing actions in the same sector and of a comparable scale to the one for which a grant is being requested.

i) For similar actions.

Please provide a detailed description of actions in the same sector and of a comparable scale to the one for which a grant is being requested managed by your organisation in the past three years.

Maximum 1 page per action.

Name of the affiliated entity
Project title
Location of the action Cost of the action (EUR) Role in the action Donors to the action (name) ?If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Amount contributed (by donor) Dates

Objectives and results of the action

ii) Other actions

Please provide a detailed description of other actions managed by your organisation in the past three years.

Maximum 1 page per action and maximum 10 actions

Name of the affiliated entity
Project title
Location of the action Cost of the action (EUR) Role in the action Donors to the action (name) ?If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Amount contributed (by donor) Dates

Objectives and results of the action


3. The applicant

EuropeAid ID number ?This number is available to an organisation which registers its data in PADOR. For more information and to register, please visit http://ec.europa.eu/europeaid/node/1100
This information is NOT obligatory for this call for proposals, but is encouraged.
Name of the organisation

3.1. Identity

The applicant’s contact details for the purpose of this action
Legal Entity File number ?If the applicant has already signed a contract with the European Commission.
Abbreviation
Registration number (or equivalent)
Date of registration
Place of registration
Official address of registration
Country of registration
Website and E-mail address of the organisation
Telephone number: Country code + city code + number
Fax number: Country code + city code + number

The Contracting Authority must be notified of any change in addresses, phone numbers, fax numbers and e-mail, in particular. The Contracting Authority will not be held responsible in the event that it cannot contact an applicant.

3.2. Profile

Legal status
Profit-Making
NGO
Value based ?Please choose only one set of values.
Is your organisation linked with another entity? please specify its EuropeAid ID:

3.2.1. Category

Category ?Please specify (1) the sector to which your organisation belongs, as defined in its statutes (or equivalent document): public (established and/or funded by a public body) OR private (established and/or funded by a private entity); (2) in the appropriate column, the category to which your organisation belongs (one choice only).

Public

Public Administration
Decentralised representatives of Sovereign States
International Organisation
Judicial Institution
Local Authority
Implementation Agency
University/Education
Research Institute
Think Tank
Foundation
Association
Media
Network/Federation
Professional and/or Industrial Organisation
Trade Union
Cultural Organisation
Commercial Organisation

Private

Implementation Agency
University/Education
Research Institute
Think Tank
Foundation
Association
Media
Network/Federation
Professional and/or Industrial
Organisation
Trade Union
Cultural Organisation
Commercial Organisation
Other Non-State Actor

3.2.2. Sector(s) ?Please tick the box for each sector your organisation has been active in the past 7 years. The sectors come from the DAC list set up by the OECD.

11. Education
111. Education, level unspecified
Education Policy & Admin. Management
Education Facilities And Training
Teacher Training
Educational Research
112. Basic education
Primary Education
Basic life skills for youth and adults
Early childhood education
113. Secondary education
Secondary education
Vocational Training
114. Post-secondary education
Higher Education
Advanced Tech. & Managerial Training
12. Health
121. Health, general
Health Policy & Admin. Management
Medical education/training
Medical Research
Medical Services
122. Basic health
Basic Health Care
Basic Health Infrastructure
Basic Nutrition
Infectious Disease Control
Health Education
Health Personnel Development
13. Population programmes
130. Population polices/programmes and reproductive health
Population Policy And Admin. Mgmt
Reproductive Health Care
Family planning
Std Control Including HIV/Aids
Personnel development for population & reproductive health
14. Water Supply and Sanitation
140. 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
15. Government and Civil Society
151. 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
152. 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
Land mine clearance
Child soldiers (prevention and demobilisation)
16. Other Social Infrastructure and Service
160. 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
21. Transport and Storage
210. Transport and storage
Transport Policy & Admin. Management
Road Transport
Rail Transport
Water Transport
Air Transport
Storage
Education & Training In Transport & Storage
22. Communications
220. Communications
Communications Policy & Admin. Mgmt
Telecommunications
Radio/Television/Print Media
Information and communication technology (ICT)
23. Energy
230. 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
24. Banking and Financial Services
240. Banking and financial services
Financial Policy & Admin. Management
Monetary institutions
Formal Sector Financial Institutions
Informal/Semi-Formal Financial intermediaries
Education/training in banking & fin. services
25. Business and Other Services
250. Business and other services
Business support services and institutions
Privatisation
31. Agriculture, Forestry and Fishing
311. 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 cooperatives
Livestock/Veterinary Services
312. Forestry
Forestry Policy & Admin. Management
Forestry development
Fuel wood/charcoal
Forestry education/training
Forestry research
Forestry services
313. Fishing
Fishing Policy And Admin. Management
Fishery development
Fishery education/training
Fishery research
Fishery services
32. Industry, Mining and Construction
321. 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
Fertiliser plants
Cement/lime/plaster
Energy manufacturing
Pharmaceutical production
Basic metal industries
Non-ferrous metal industries
Engineering
Transport equipment industry
Technological research and development
322. 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
Fertiliser minerals
Offshore minerals
323. Construction
Construction Policy And Admin. Mgmt
33. Trade and Tourism
331. Trade policy and regulation
Trade Policy And Admin. Management
Trade facilitation
Regional trade agreements (RTAs)
Multilateral trade negotiation
Trade education & training
332. Tourism
Tourism Policy And Admin. Management
41. General Environment Protection
410. General environmental protection
Environmental Policy And Admin. Mgmt
Biosphere protection
Bio-diversity
Site Preservation
Flood Prevention/Control
Environmental education/training
Environmental research
43. Other multisector
430. Other multisector
Multisector Aid
Urban Development And Management
Rural Development
Non-agricultural alternative development
Multisector education/training
Research/scientific institutions
51. General budget support
510. General budget support
General budget support
52. Development food aid/food security
520. Development food aid/food security assistance
Food Aid / Food Security Programmes
53. Other commodity assistance
530. Other commodity assistance
Import support (capital goods)
Import support (commodities)
60. Action relating to debt
600. 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
72. Emergency and distress relief
720. Emergency and distress relief
Material relief assistance and services
Emergency food aid
Relief coordination; protection and support services
73. Reconstruction relief and rehabilitation
730. Reconstruction relief and rehabilitation
Reconstruction relief and rehabilitation
74. Disaster prevention and preparedness
740. Disaster prevention and preparedness
Disaster prevention and preparedness
91. Administrative costs of donors 92. Support to NGO
920. Support to NGO
Support to national NGOs
Support to international NGOs
Support to local and regional NGOs
93. Refugees
930. Refugees (in donor countries)
Refugees (in donor countries)
99. Unallocated/unspecified
998. Unallocated/unspecified
Sectors Not Specified
Promotion of Development Awareness

3.2.3. Target group(s)

All
Child soldiers
Children (less than 18 years old)
Community Based Organisation(s)
Consumers
Disabled
Drug consumers
Educational organisations (school, universities)
Elderly people
Illness affected people (Malaria, Tuberculosis, HIV/AIDS)
Indigenous peoples
Local authorities
Migrants
Non Governmental Organisations
Prisoners
Professional category
Refugees and displaced
Research organisations/Researchers
SME/SMI
Students
Urban slum dwellers
Victims of conflicts/disasters
Women
Young people

Other (please specify):

3.3. Capacity to manage and implement actions

3.3.1. Experience by sector

Sector Year(s) of Experience Experience in the past 7 years Number of Projects in the past 7 years Estimated amount
(in thousand euros) in the past 7 years

3.3.2. Experience by geographical area

By geographical area (country or region) Year(s) of experience Number of projects in this geographical area in the past 7 years Estimated amount
(in thousand euros) invested in this geographical area in the past 7 years

Cross-reference of experience by sector and by geographical area:

Sector(s)
(as selected in 3.2.2)
Geographical area(s)
(country or region, as identified previously)

3.3.3. Resources

Financial data

Please provide the following information, if applicable, on the basis of the profit and loss account and balance sheet of your organisation, amounts in thousands euros

Financial Year Turnover or equivalent Net earnings or equivalent Total balance sheet Shareholders’ equity or equivalent Medium and long-term debt Short term debt (<1 year)
2013
2012
2011
Financing Source(s)

Please specify the source(s) of the revenues of your organisation and the additional information requested

2013
Source Percentage
EU
Member States’ Public Bodies
Third Countries’ Public Bodies
United Nations
Other International Organisation(s)
Private Sector
Membership fees (number of fee-paying members: )
Other (please specify):
Total (must be equal to 100%)
2012
Source Percentage
EU
Member States’ Public Bodies
Third Countries’ Public Bodies
United Nations
Other International Organisation(s)
Private Sector
Membership fees (number of fee-paying members: )
Other (please specify):
Total (must be equal to 100%)
2011
Source Percentage
EU
Member States’ Public Bodies
Third Countries’ Public Bodies
United Nations
Other International Organisation(s)
Private Sector
Membership fees (number of fee-paying members: )
Other (please specify):
Total (must be equal to 100%)

Not mandatory, but encouraged to be filled in in case of availability. A copy of external audit report may be provided instead of a copy of the applicant’s latest accounts, if the accounts are in practice the same documents as the external audit report.

Year Name of approved auditor Period of validity
2013
2012
2011
Number of staff (full-time equivalent)

please tick one option for each type of staff

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

3.4. List of the management board/committee of your organisation

Name Profession Function Country of Nationality On the board since




4. The Co-applicant(s)

This section must be completed for each co-applicant within the meaning of Section 2.1.1 of the Guidelines for Applicants. You must make as many copies of this table as necessary to create entries for each additional co-applicant.





5. AFFILIATED ENTITY(ies) participating in the action

5.1. Description of the affiliated entity(ies)

This section must be completed for each affiliated entity within the meaning of Section 2.1.2 of the Guidelines for Applicants. You must make as many copies of this table as necessary to create entries for each affiliated entity.





6. Associates of the applicant participating in the action

This section must be completed for each associated organisation within the meaning of Section 2.1.3 of the Guidelines for Applicants. You must make as many copies of this table as necessary to create entries for more associates.





7. Checklist for the full application form

Administrative data

Name of the Applicant
EuropeAid ID number
Country and date of registration
Legal Entity File number ?If the applicant has already signed a contract with the European Commission.
Legal status ?E.g. non-profit, governmental body, or international organisation.


Co-applicant ?Add as many rows as co-applicant(s)

Name of the co-applicant
EuropeAid ID number
Nationality/Country and date of registration
Legal Entity File number
Legal status


Affiliated entity ?Add as many rows as affiliated entities

Name of the Affiliated-Entity
EuropeAid ID number
Country and date of registration
Legal status
Specify to which entity you are affiliated (applicant and/or the co-applicant)
Specify the kind of affiliation you have with that entity

BEFORE SENDING YOUR PROPOSAL, PLEASE CHECK THAT EACH OF THE FOLLOWING CRITERIA HAVE BEEN MET IN FULL AND TICK THEM

PART 1 (ADMINISTRATIVE)

The correct grant application form has been used
The Declaration by the Applicant has been filled in and signed
The proposal is typed and is in English
One original and 2 copies are included
An electronic version of the proposal (CD-Rom) is enclosed
Each co-applicant has completed and signed the mandate and the mandate is included
Each affiliated entity(ies) has completed and signed a affiliated entity(ies) 's statement and the statements are included. Please write ‘Not applicable’ (NA) if you have no affiliated entity(ies).
The budget is enclosed, presented in the format requested, and stated in EUR
The logical framework has been completed and is enclosed
The Lead Applicant has submitted only one application

PART 2 (ELIGIBILITY)

The duration of the action is between 6 months and 18 months (the minimum and maximum allowed)
The requested contribution is between 20’000 EURO and 200’000 EURO (the minimum and maximum allowed)
The requested contribution is not more than 90% of the estimated total eligible costs (maximum percentage allowed)


8 Declaration by the applicant

The applicant, represented by the undersigned, being the authorised signatory of the applicant, in the context of the present call for proposals, representing any co-applicant(s), affiliated entity(ies) in the proposed action, hereby declares that

  • the applicant has the sources of financing specified in Section 2 of the Guidelines for Applicants;
  • the applicant has sufficient financial capacity to carry out the proposed action or work programme;
  • the applicant certifies the legal statutes of the applicant, of the co-applicant(s) and of the affiliated entity(ies) as reported in part 3, 4, and 5 of this application;
  • the applicant, the co-applicant(s) and the affiliated entity(ies) have the professional competences and qualifications specified in Section 2 of the Guidelines for Applicants;
  • the applicant undertakes to comply with the obligations foreseen in the affiliated entity(ies)'s statement of the grant application form and with the principles of good partnership practice;
  • the applicant is directly responsible for the preparation, management and implementation of the action with the co-applicant(s) and affiliated entity(ies), if any, and is not acting as an intermediary;
  • if the requested amount is above EUR 60,000, the applicant and the co-applicant(s) and the affiliated entity(ies) are not in any of the situations excluding them from participating in contracts, which are listed in Section 2.3.3 of the Practical Guide to contract procedures for EU external actions (available from the following Internet address: http://ec.europa.eu/europeaid/prag/document.do?locale=en. Furthermore, it is recognised and accepted that if the applicant, co-applicant(s) and affiliated entity(ies) participate in spite of being in any of these situations, they may be excluded from other procedures in accordance with Section 2.3.4 of the Practical Guide;
  • the applicant and each co-applicant and affiliated entity (if any) is in a position to deliver immediately, upon request, the supporting documents stipulated under Section 2.4 of the Guidelines for Applicants.
  • the applicant and each co-applicant and affiliated entity (if any) are eligible in accordance with the criteria set out under Sections 2.1.1 and 2.1.2 of the Guidelines for Applicants;
  • if recommended to be awarded a grant, the applicant accepts the contractual conditions as laid down in the Standard Contract annexed to the Guidelines for Applicants (annex G);
  • the applicant, the co-applicant(s) and the affiliated entity(ies) are aware that, for the purposes of safeguarding the financial interests of the EU, their personal data may be transferred to internal audit services, to the European Court of Auditors, to the Financial Irregularities Panel or to the European Anti-Fraud Office.

These are the sources and amounts of Union funding received or applied for the action or part of the action or for its functioning during the same financial year as well as any other funding received or applied for the same action

<list source and amount and indicate status (i.e. applied for or awarded)>

The applicant is fully aware of the obligation to inform without delay the Contracting Authority to which this application is submitted if the same application for funding made to other European Commission departments or European Union institutions has been approved by them after the submission of this grant application.

The applicant acknowledges that according to Article 131 (5) 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, p.1) applicants found guilty of misrepresentation may be subject to administrative and financial penalties under certain conditions.

Signed on behalf of the applicant

Name
Position
Date and place

9. Budget for the Action ?The description of items must be sufficiently detailed and all items broken down into their main components. The number of units and the unit value must be specified for each item depending on the indications provided. The budget has to include costs related to the Action as a whole, regardless the part financed by the Contracting Authority.

CostsUnit # of units Unit value
(in EUR)
Total Cost
(in EUR) ?If the Contracting Authority is not the European Commission, the budget may be established in euro or in the currency of the country of the Contracting Authority. Costs and unit values are rounded to the nearest euro cent.
Clarification of the budget items ?Provide a narrative clarification of each budget item demonstrating the necessity of the costs and how they relate to the action (e.g. through references to the activities and/or results in the Description of the Action). Justification of the estimated costs ?Provide a justification of the calculation of the estimated costs. Note that the estimation should be based on real costs or on simplified cost options if allowed, as described in section 2.1.5 of the Guidelines for Grants Applicants
1. Human Resources
1.1 Salaries (gross salaries including social security charges and other related costs, local staff) ?If staff are not working full time on the Action, the percentage should be indicated alongside the description of the item and reflected in the number of units (not the unit value).
1.1.1 Technical
1.1.2 Administrative/ support staff
1.2 Salaries (gross salaries including social security
charges and other related costs, expat/int. staff)
1.3 Per diems for missions/travel ?Indicate the country where the per diems are incurred.
1.3.1 Abroad (staff assigned to the Action)
1.3.2 Local (staff assigned to the Action)
1.3.3 Seminar/conference participants
Subtotal Human Resources
2. Travel ?Costs for C02 offsetting of air travel may be included. C02 offsetting shall in that case be achieved by supporting CDM/Gold Standard projects (evidence must be included as part of the supporting documents) or through airplane company programmes when available. Indicate the place of departure and the destination. If information is not available, enter a global amount.
2.1. International travel
2.2 Local transportation
Subtotal Travel
3. Equipment and supplies ?Please separate cost for purchase or rental.
3.1 Purchase or rent of vehicles
3.2 Furniture, computer equipment
3.3 Machines, tools…
3.4 Spare parts/equipment for machines, tools
3.5 Other (please specify)
Subtotal Equipment and supplies
4. Local office
4.1 Vehicle costs
4.2 Office rent
4.3 Consumables - office supplies
4.4 Other services (tel/fax, electricity/heating, maintenance)
Subtotal Local office
5. Other costs, services ?Specify the typology of costs or services. Global amounts will not be accepted.
5.1 Publications ?Only indicate here when fully subcontracted.
5.2 Studies, research ?Only indicate here when fully subcontracted.
5.3 Expenditure verification/Audit
5.4 Evaluation costs
5.5 Translation, interpreters
5.6 Financial services (bank guarantee costs etc.)
5.7 Costs of conferences/seminars ?Only indicate here when fully subcontracted.
5.8. Visibility actions ?Communication and visibility activities should be properly planned and budgeted at each stage of the project implementation.
Subtotal Other costs, services
6. Other
6.1.
6.2.
6.3.
6.4.
6.5.
Subtotal Other
7. Subtotal direct eligible costs of the Action (1-6)
8. Provision for contingency reserve (maximum 5% of 7, subtotal of direct eligible costs of the Action)
9. Total direct eligible costs of the Action (7+ 8)
10. Indirect costs (maximum 7% of 9, total direct eligible costs of the Action)
11. Total eligible costs (9+10)

NB: The Beneficiary(ies) alone are responsible for the correctness of the financial information provided in these tables.

Expected sources of funding & summary of estimated costs ?Expected sources of funding and estimated costs must be in balance. It is reminded that the figures introduced in the table shall respect all the points included in the checklist for the full application form (part 7 of the full application form)

Expected sources of fundingAmount (EUR)
EU/EDF contribution sought in this application (A)
Other contributions (Applicant, other Donors etc)
NameConditions ?with reference to art.17.4 (b) of the General Conditions

Revenue from the Action

Expected TOTAL CONTRIBUTIONS
Estimated Costs
Estimated TOTAL ELIGIBLE COSTS ?as per heading 11 of the Budget of the Action (B)
EU/EDF contribution expressed as a percentage of total eligible costs ?do not round, enter percentage with 2 decimals (e.g. 74,38%) (A/B x 100) %

Congratulations! You have successfully passed the e-training on filling in the application form under the Eastern Partnership Territorial Cooperation Programme Call for Proposals.

We hope that it was useful and will help you to further proceed with the offline application.

The application form and specific requirements, as well as useful information for applicants, can be found in the Guidelines for Applicants at: http://eaptc-ma.eu/en/