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EUROPEAN COMMISSIONEUROSTAT

Directorate C: National Accounts, Prices and Key Indicators

OPEN CALL FOR PROPOSAL 2014

GRANT APPLICATION FORM FOR AN ACTION

(Monobeneficiary)

PROGRAMME CONCERNED

Commission Implementing Decision of 17/02/2014 concerning the adoption of the work programme and financing decision for 2014 for the implementation of the European Statistical Programme 2013-2017

Regulation (EU) No 99/2013 of the European Parliament and of the Council of 15 January 2013 on the European statistical programme 2013-17

REFERENCE NUMBER OF THE CALL FOR PROPOSALS

21040/2014/003

GENERAL INFORMATION ON THE ACTION

EUROSTAT GRANT FOR 2014 – OPEN CALL FOR PROPOSAL

EUROSTAT UNIT: C TF-EPSAS

OBJECTIVE: 02.1 Develop and enhance statistics for the economic governance of the EU

TITLE: PREPARATORY WORK FOR THE MODERNISATION OF PUBLIC SECTOR ACCOUNTING SYSTEMS ON AN ACCRUALS BASIS

Date of first application:

Date of the modified version:

SUMMARY OF THE APPLICATION

Title:

Identity of the applicant:

Duration (in months):

Total estimated cost (in €):

Requested grant (in €):

Percentage of the requested grant (co-financing):

Before filling in this form, please read carefully the call for proposal and the attached documents.

An application will be accepted only if:

It is submitted on the correct form, completed in full and dated;

It is signed by the person authorised to enter into legally binding commitments on behalf of the applicant;

It shows a budget in conformity with the funding rules;

It meets the submission arrangements set in the call for proposal and its annexes;

It is submitted by the deadline.

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I. INFORMATION ON THE APPLICANT

1.1 IDENTITY OF THE APPLICANT1

Official name in full:

Acronym: (if applicable)

Official legal form:

Company registration number2:

VAT number5:

1.2 CONTACT DETAILS

Street address:

Postcode:

Town/City:

Region (if applicable):

Country:

Telephone:

Fax:

E-mail address:

WEB site:

1.3 CONTACT PERSON RESPONSIBLE FOR THE PROPOSAL

Family name:

First Name:

Position/Function3:

Telephone:

Fax:

E-mail address:

1 Please fill in the Legal Entity Form only if you apply for the first time for Eurostat grants.http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm

2 Not applicable if the applicant is a public-sector body3 The contact person is in principle the project leader.

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

1.4 LEGAL REPRESENTATIVE AUTHORISED TO SIGN THE APPLICATION

Family name:

First Name:

Position/Function:

Telephone:

Fax:

E-mail address:

1.5 LEGAL REPRESENTATIVE AUTHORISED TO SIGN THE GRANT AGREEMENT (if different from the person mentioned above in 1.4)

Family name:

First Name:

Position/Function:

Telephone:

Fax:

E-mail address:

1.6 BANK DETAILS4

Name of the bank:

Branch:

Address:

Number/Street:

Country/postcode:

Town/city:

Account number5:

IBAN N°:

Precise denomination of the account holder:

4 Please fill in the Financial Identification Form only if you apply for the first time or if you will use a new bank account, http://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm

5 Please fill in only if IBAN is not available.

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http://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm

2. INFORMATION ON AFFILIATES OF THE APPLICANT 6 (if applicable)

2.1 IDENTITY OF THE AFFILIATE7 <X>

OFFICIAL NAME IN FULL:

ACRONYM: (IF APPLICABLE)

OFFICIAL LEGAL FORM:

COMPANY REGISTRATION NUMBER:8

VAT NUMBER:11

2.2 CONTACT DETAILS

STREET ADDRESS:

POSTCODE:

CITY:

REGION (IF APPLICABLE):

COUNTRY:

TELEPHONE:

FAX:

E-MAIL ADDRESS:

2.3 PERSON RESPONSIBLE FOR THE OPERATIONAL PERFORMANCE OF THE TASKS

FAMILY NAME:

FIRST NAME:

POSITION/FUNCTION:

TELEPHONE:

FAX:

E-MAIL ADDRESS:

6 Repeat this part for each affiliate. 7 Please fill in the Legal Entity Form only if the affiliate applies for the first time.

http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm8 Not applicable if the applicant is a public-sector body

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2.4 LEGAL REPRESENTATIVE AUTHORISED TO SIGN THE DECLARATION9

FAMILY NAME:

FIRST NAME:

POSITION/FUNCTION:

TELEPHONE:

FAX:

E-MAIL ADDRESS:

9 Person authorised to enter into legally binding commitments on behalf of the affiliated entity.

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II. ELIGIBILITY, EXCLUSION AND SELECTION CRITERIA(OPERATIONAL CAPACITY)

1 ELIGIBILITY10

1.1 Applicant's category:

Public body: Yes

Non-profit making organisation: Yes if yes: private or public

Moreover, eligible beneficiaries must be Member States' public sector accounting regulators, in particular public sector standard-setting authorities and those public entities which have a responsibility for leading or coordinating the implementation of public sector accounting standards across or between general government sub-sectors. In line with ESA2010, general government comprises central, state and local governments, and social security funds.

1.2 Does the applicant envisage to cooperate with an affiliate?

Yes No

If "yes", please

explain the legal (or capital) link you have with the affiliate and

provide a document proving this link (unless already done so for an earlier application in the current year)

The applicant (and affiliate(s)) should provide - a short description of the organisation, where appropriate including, information on membership, with respect to the eligibility criteria indicated in the specific call- supporting documents as specified in the call for proposalTo be completed:………….

2 EXCLUSION

Grants may not be awarded to applicants (and their affiliates, if applicable) who are, at the time of a grant award procedure, in one of the situations referred to in Articles 106 (1), and 107 to 109 of the Financial Regulation (FR) 11. Accordingly, a declaration is included in part V of this application.

10 This part does not apply for national statistical authorities or other national authorities responsible for the development, production and dissemination of European statistics included on Article 5 of Regulation N°223/2009 of the European Parliament and of the Council of 11/03/2009 on European Statistics.

11 Regulation (EU, EURATOM) No 966/2012 of the European Parliament and of the Council of 25 October 2012 on the financial rules applicable to the general budget of the Union and repealing Council Regulation (EC, Euratom) No 1605/2002

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3 SELECTION CRITERIA

3.1 OPERATIONAL CAPACITY

In this box, the applicant shall provide:

- A list of previous projects and activities performed and connected to the policy field of a given call or to the actions to be carried out in the last 3 years;- supporting documents as specified in the call for proposal;

The applicant (and his affiliate) must have the operational (technical and management) capacity to complete the specific action. The Commission reserves the right to request any additional information to assess the operational capacity of the applicant (and affiliate) to be provided within a time-limit stipulated in its request.

If the applicant (and affiliate) has to conclude contracts in order to carry out part of the action, the recourse to the award of contracts must be justified having regard to the nature of the action and what is necessary for its implementation. The description of the action (see Part III.1.c) must include information on the role, activity and responsibility of each subcontractor. Rules have already been foreseen in the financial regulation and the standard grant agreement where implementation of an action requires the award of procurement contracts (see Articles I.10.2 and II.9.2). It is assumed that the beneficiary (and his affiliate) is competent for carrying out and managing directly the major part of the action. Situations where a beneficiary simply acts as intermediary must be avoided. In any case the beneficiary is sole responsible for the whole action and for compliance with the provisions of the agreement. Note and take into account that Eurostat should not have direct contact with the subcontractor(s) during the implementation of the action.

To be completed:………….

3.2 FINANCIAL CAPACITY12

LEGAL NOTICE

Where the application concerns grants for an action for which the amount exceeds EUR 750 000 an audit report produced by an approved external auditor must be submitted. This report should certify the accounts for the last financial year available.

This does not apply to public bodies.

PROOF OF FINANCIAL CAPACITY

The applicant should provide the following documents as evidence of financial capacity:

• Balance sheets or extracts from balance sheets for the last financial year for which the accounts have been closed.

• Profit and loss account for the last financial year for which the accounts have been closed. For newly created entities, the business plan will replace closed accounts.

12 The verification of the financial capacity does not apply to public bodies.

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III. INFORMATION ON THE ACTION(S) FOR WHICH THE GRANT IS REQUESTED

1 DESCRIPTION OF THE ACTION

Title:

a) Description of the general and specific objectives that the action aims to achieve:Specify also related indicators to assess the action's achievements and expected impact, if possible.

b) Description of the action (on the basis of the main activities foreseen) and where it will be implemented:

c) Organisation of the project management:The applicant should provide a detailed description of the organisation of the action and of the implementation phase, specifying arrangements for monitoring, supervision, risk management and if an affiliate is involved which part of the action will be carried out by the affiliate.

Where subcontracting is envisaged specify in particular, the tasks to be subcontracted and, if known,the selection procedure which will be used.

d) Methodology to be followed, expected results and their use:

The applicant should explain the methodology, both theoretical and practical, that will be followed in order to meet the general and specific objectives of the action described above. The applicant should specify the benchmarks or deliverables which the applicant intends to employ to achieve the expected results and targets and how they will be used and disseminated.

e) Arrangements for monitoring/supervision during the operation and foreseen risks about the implementation:The applicant should provide effective explanations about the supervision of the action and should state the presence of any possible risk in the implementation of it, and how it could affect the objectives and outcomes of the action or how it could be mitigated.

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f) Sustainability of the project's achievements:The applicant should explain how the sustainability will be secured after the completion of the action. It can include considerations about different dimensions of sustainability: financial, economics, institutional (structures which would allow the results of the action to continue), environmental, policy, etc (if applicable, depending upon the provisions of the basic act).

2 PLANNED DURATION OF THE ACTION (in months): xx

Planned starting date:

Please choose one of the following options:13

Option 1: The action shall start the first day following the date the last party has signed the grant agreement.

Option 2: The action shall start xx 14 calendar days following the date the last party has signed the grant agreement.

LEGAL NOTICEApplicants are informed that, under the Financial Regulation applicable to the general budget of the European Union, no grant may be awarded retrospectively for actions already completed, and that in the exceptional cases accepted by the Commission where applicants can demonstrate the need to start the action or work programme before the agreement is signed, expenditure eligible for financing may not have been incurred before the grant application was lodged.

Shall your action begin before the grant agreement is signed? Yes No

If yes, you have to provide below a justification which demonstrates the need to start the action before the grant agreement is signed: (to be completed)……………..

2.(a) TIMETABLE TO CARRY OUT EACH STAGE OF THE ACTION SHOWING MAIN DATES AND EXPECTED RESULTS FOR EACH STAGE15

Tasks / Results / Reports Timetable

Preparation Activity 1 …

Progress report M16 + 6

Final technical report on implementation of the action and financial statement

60 days following the closing date of the action

13 Please delete and keep just the option chosen.14 The action shall start 1 to 30 calendar days following the date the last party has signed the grant agreement.15 Table to be repeated as many times as necessary.16 M being the start of the action. Don't use fixed dates in order to avoid problems in case of changes in the implementation of the action.

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3 BUDGET

Fill in Annex III - Estimated Budget Applications must include a detailed estimated budget in balance in which all costs are given in euro. Applicants from countries outside the euro zone may use either the conversion rates published in the Official Journal of the European Union, series C, during the month in which they are submitting the application, or the monthly rate published on the Commission's website at www.ec.europa.eu/budget/inforeuro/.Note that when declaring your costs at the end of the action you will have to use the conversion rate as defined in the grant agreement.

3.1. Use of scales of unit costs for direct eligible personnel costs

(applicable only for the National Statistical Institutes authorised by the respective Commission Decision17)

Will you apply scales of unit costs for the declaration of direct personnel costs?

Yes 18 No

3.2. Costs related to horizontal services (such as financial management, human resources, training, legal advice, IT, etc.) are covered by the flat-rate and can not be included under heading “Costs of staff assigned to the action”. Therefore, administrative staff is eligible only if directly linked to the technical performance of the action. This is equally true for the general involvement of high management staff.

In case you foresee administrative staff’s tasks, can you confirm that they are compliant with the above rule?

Yes: Not applicable:

In case you foresee the involvement of high management staff please provide explanation:

Yes: Explanation: ……………………

Not applicable:

17 COMMISSION DECISION of 23 May 2013 on the approval of the methodology to establish scales of unit costs for direct personnel costs and flat rate funding for grants awarded to bodies identified in Article 5 of Regulation (EC) No 223/2009 of the European Parliament and of the Council on European statistics.

18 In case you will apply scales of unit costs, use exactly the same categories and the relevant salary rates mentioned in respective Commission Decision.

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http://www.ec.europa.eu/budget/inforeuro/

IV. OTHER FUNDING

1 UNION FUNDING

1.1 IN PREVIOUS YEARS

Has the applicant (or his affiliate, if applicable) already obtained any Union grants, contracts or loans from a Union Institution or body/agency of the Union, directly or indirectly for similar/complementary action(s) during the last 2 years?

NO

YES – from Eurostat (no information to be provided)

YES – from other Union Institution or body/agency of the Union (Continue to the following table )

GRANT, PROCUREMENT CONTRACT OR LOAN DETAILS

To be specified for each of them (previous years - add columns if necessary)

Title

Union Programme concerned

Union Institution or Body/Agency which took the award decision

Year of award and duration of the operation

Value of the grant, contract or loan

1.2 CURRENT YEAR

Has the applicant submitted grant/loan applications for similar/complementary action(s) or offers of service or an operating grant to the Union Institutions/bodies/agencies in the current year?

NO

YES – from Eurostat (no information to be provided)

YES – from other Union Institution or body/agency of the Union (Continue to the following table )

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GRANT, CONTRACT OR LOAN DETAILS

To be specified for each of them (past years - add columns if necessary)

Title

Union Programme concerned

Union Institution or Body/Agency which will take the award decision

Planned duration of the operation

Estimated value of the grant, contract or loan

LEGAL NOTICE

The applicant must inform the Commission department to which this application is submitted if any of the above mentioned applications for funding made to other European Commission departments or Union Institutions or bodies/agencies has been approved by them after the submission of this grant application.

2 FINANCIAL CONTRIBUTIONS FROM THIRD PARTIES (EXTERNAL SPONSORS)

SUPPORT AWARDED:Has the applicant already requested (or received confirmation) of any external funding for the action?

NO

YES – Continue to the table below and fill in the Estimated budget

AWARDED OR REQUESTED CONTRIBUTIONS BY THIRD PARTIESThe applicant should indicate the details following the model below – same listed in the budget (add rows if necessary)Official name of the third party in full

Official legal form

Official address

E-mail address

Estimated amount of funding to be provided for the action

Pre-allocation of funding (if any)

Conditions or reservations (if any)

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REQUESTED SUPPORT:

Has the applicant requested, applied or are awaiting confirmation relating to any external funding for the action/working programme?

NO

YES – Continue to the table in the Annexes (Budget)

DETAILS OF FUNDS REQUESTEDThe applicant should indicate the details of the sponsors following the model below (add rows if necessary)Organisation/Entity Concerned

Name of the organisation

Official address

E-mail address

Requested amount

LEGAL NOTICE

In accordance with Article 35 of the Financial Regulation concerning transparency, grants awarded in the course of a financial year shall be published annually.

The applicant has the right to object to the publication if such disclosure risks threatening the rights and freedoms of individuals concerned as protected by the Charter of Fundamental Rights of the European Union or harm the commercial interests of the recipients.

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V. DECLARATION BY THE APPLICANT

The undersigned [insert name of the signatory of this form]:

representing the following legal person:

full official name:

official legal form:

full official address:

VAT registration number:

authorised to represent the applicant, hereby requests from the Commission a grant 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 the applicant has not received any other Union funding to carry out the action that is the subject of this grant application.

I certify that the applicant is not in one of the situations which would exclude it from receiving Union grants and accordingly

declare that the applicant:

a) is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors, has not suspended business activities, is not the subject of proceedings concerning those matters, or is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

b) has not 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 not been guilty of grave professional misconduct proven by any means which the Commissioncan justify including by decisions of the European Investment Bank and international organisations;

d) is 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 is to be implemented;

e) has not 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 not subject to an administrative penalty for being guilty of misrepresenting the information required as a condition of participation in a procurement procedure or another grant award procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts or agreements covered by the Union's budget.

declare that the applicant:

g) has 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;

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i) has not granted and will not grant, has not sought and will not seek, has not attempted and will not attempt to obtain, and has 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 with the EC contribution over 60 000 EUR, the following evidence shall be provided upon request and within the time limit set by the Commission:

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 applicant is fully eligible in accordance with the criteria set out in the specific invitation to submit an application.

I certify that the applicant has 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, p.1) applicant found guilty of misrepresentation may be subject to administrative and financial penalties under certain conditions.

If selected to be awarded a grant, the applicant accepts the general conditions as laid down in the grant agreement.

Last name, first name:

Signature of the applicant:

Date:

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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 Head of Eurostat Unit A4 – Financial Management. 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 on

http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE )

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http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE


http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf

V.1 - DECLARATION BY THE AFFILIATE 19

The undersigned [insert name of the signatory of this form]:

representing the following legal person:

full official name:

official legal form:

full official address:

VAT registration number:

authorised to represent the affiliate, hereby requests from the Commission a grant 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 the affiliate has not received any other Union funding to carry out the action that is the subject of this grant application.

I certify that the affiliate is not in one of the situations which would exclude it from receiving Union grants and accordingly

declare that the affiliate:

a) is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors, has not suspended business activities, is not the subject of proceedings concerning those matters, or is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

b) has not 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 not been guilty of grave professional misconduct proven by any means which the Commission can justify including by decisions of the European Investment Bank and international organisations;

d) is 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 is to be implemented;

e) has not 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 not subject to an administrative penalty for being guilty of misrepresenting the information required as a condition of participation in a procurement procedure or another grant award procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts or agreements covered by the Union's budget.

declare that the affiliate:

g) has 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;

19 In case the action is proposed in cooperation with one of more affiliate(s) add this declaration for each of them.

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i) has not granted and will not grant, has not sought and will not seek, has not attempted and will not attempt to obtain, and has 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 with the EC contribution over 60 000 EUR, the following evidence shall be provided upon request and within the time limit set by the Commission:

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 affiliate is fully eligible in accordance with the criteria set out in the specific invitation to submit an application.

I certify that the affiliate has 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, p.1) affiliate found guilty of misrepresentation may be subject to administrative and financial penalties under certain conditions.

If selected to be awarded a grant, the affiliate accepts the general conditions as laid down in the grant agreement.

Last name, first name:

Signature of the affiliate:

Date:

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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 Head of Eurostat Unit A4 – Financial Management. 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)

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http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE



http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf

CHECK-LIST FOR APPLICANTS

All sections of the application form have been filled in.

Declaration by the applicant has been duly signed by the legal representative of the applicant's organisation.

The estimated budget has been duly filled in and is attached.

The supporting documents concerning eligibility criteria have been included in the application form.

The supporting documents concerning operational capacity have been included in the application form.

If applicable, balance sheets for the last year for which accounts have been closed have been included with the application form.

If applicable, profit and loss account for the last financial year for which the accounts have been closed has been included with the application form.

If applicable, official document proving the legal (or capital) link of the affiliate with the applicant

If applicable, the declaration of the affiliate has been filled in and is duly signed

If applicable, bank details have been included in the Financial Identification Form

If applicable, the legal entity form has been icluded

If applicable, audit report by an approved external auditor on the accounts of the last financial year available has been included with the application form.

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