proposal submission forms · web vieweuropean commission trans-european transport network a1...

Proposal Submission FormsEUROPEAN COMMISSION TRANS-EUROPEAN TRANSPORT NETWORK

A1Proposal Nr.

Multi-Annual Programme 2007-2013Annual Programme

GENERAL INFORMATION ON THE PROPOSAL

Title of the proposed action

Priority/Horizontal project ▼ Section (only for PP) ▼Transport mode ▼Start date of the Action End date of the Action

Summary (up to 2000 characters)

Proposal field

Please enter the proposal field:

Proposal field:

Proposal type

Please ‘tick’ the box with the proposal type:

StudyWork

For ERTMS proposals only:

Trackside infrastructureOn board equipment


A2.1Proposal Nr. Applicant Nr

INFORMATION ON ORGANISATIONS

Organisation legal name

Administrative data

Legal addressStreet name Number

Town / City Postal Code / Cedex Country

Legal status of the applicant

Please ‘tick’ the box with the legal status of the applicant.

Member StatePublic Undertaking or BodyPrivate Undertaking or BodyInternational Organisation (*)Joint Undertaking (*)

(*)Please attach the letter(s) containing the approval of the Member State(s) concerned.

For multi-beneficiary proposals only.

Coordinating applicant

2



Contact points

Contact personFamily Name First name(s) Function Is the address different from the legal address? YES/NO Street name Number

Town / City Postal code / Cedex Country Phone Fax E-mail

Authorised representative to sign this applicationFamily Name First name(s) Function Is the address different from the legal address? YES/NO Street name Number


Date Stamp (*) and signature

(*) As foreseen by the ministry concerned.



FINANCIAL IDENTIFICATION

Account holder

Family name (1) First name(s) Street name Number

Town / City Postal code / Cedex Country

Contact person

Family name First name(s) Phone Fax E-mail

Bank

Bank Name Branch addressStreet name Number


Account number IBAN (2)

REMARKS:

BANK STAMP + SIGNATURE OF BANK REPRESENTATIVE(Both Obligatory)(3)

DATE + SIGNATURE ACCOUNT HOLDER :(Obligatory)

Date:

(1) The name or title under which the account has been opened and not the name of the authorized agent.(2) If the IBAN Code (International Bank account number) is applied in the country where your bank is situated.(3) It is preferable to attach a copy of recent bank statement, in which event the stamp of the bank and the signature of the bank's representative are not required. The signature of the account-holder is obligatory in all cases.



IF YOUR ORGANISATION IS A MEMBER STATE, INTRODUCE BELOW THEPUBLIC OR PRIVATE UNDERTAKING OR BODY(IES) WHICH WILL IMPLEMENT THE ACTION

Organisation legal name

Administrative data



(*) If there are more than one implementing body, please introduce them all.

IF YOUR ORGANISATION IS A PUBLIC OR PRIVATE UNDERTAKING OR BODY, INTRODUCE BELOW THEMEMBER STATE APPROVING THIS APPLICATION

Ministry legal name

Administrative data



Authorised representative to sign this applicationFamily name First name(s) Function Is the address different from the legal address? YES/NO Street name Number


Date Stamp (*) and signature

(*) As foreseen by the ministry concerned.


A3.1Proposal Nr.

LOCATION OF THE ACTION

Member State(s) ▼ ▼ ▼ ▼ ▼Region(s) (1) ▼ ▼ ▼ ▼ ▼

(1) Regions will be given following NUTS 2 nomenclature.

Geographical co-ordinates

Long (X) (2) Lat (Y) (2)Start point Interim point 1 Interim point 2 … Interim point n End point

(2) Long & lat must be given in a seven digit number (+ or - sign followed by three digits and by four decimals).

ACTIVITIES OF THE ACTION

Activity number

ISIC code (3)

Activity name Start date

End date

Verifying milestone

▼ ▼ ▼ ▼

(3) For complete description and other codes, see: http://unstats.un.org/unsd/cr/registry/regcst.asp?Cl=17

MILESTONES OF THE ACTION

Milestone number

Milestone name(including milestones at start and end date of the Action)

Expected date

Means of verification

CONTRIBUTION OF THE ACTION TO THE TEN-T POLICY OBJECTIVES

If the Action is part of a Global Project previously supported under the TEN-T budget, please specify:

Decision number Title

http://unstats.un.org/unsd/cr/registry/regcst.asp?Cl=17


A3.2Proposal Nr.

FINANCIAL INFORMATION

Global project

SOURCES OF FINANCING Contribution1. State budget (-s) 2. Regional/local budget 3. Project promoter (Public or Private) 4. EIB loan 5. Other loans 6. TEN financing 7. Other EU funds (ERDF, CF, FPR) 8. Other sources Total

For multi-beneficiary projects, please give only the total amounts per category.

Proposed Action

SOURCES OF FINANCING (*) Total proposed

contribution

2008 2009 2010 2011 2012 2013 >2013

1. State budget(s) 2. Regional/local budget(s) 3. Action promoter(Public or Private)

4. EIB loan 5. Other loans 6. TEN financing 7. Other EU funds 8. Other sources Total

(*) Contribution to eligible costs only.

For multi-beneficiary actions, please split state and regional budgets by applicant.


A3.3Proposal Nr.

INDICATIVE BREAKDOWN OF ESTIMATED ELIGIBLE COSTS OF THE PROPOSED ACTION BY ACTIVITIES

Activities 2008 2009 2010 2011 2012 2013 >2013 Total eligible cost

1.DIRECT COST 1.1 Activity 1 1.2 Activity 2 1.3 Activity 3 1.4 Activity 4 1.5 Activity 5 1.6 Activity 6 …. 1.N Activity N SUBTOTAL DIRECT COST 2. INDIRECT COSTFlat rate funding up to 7% of total direct cost

TOTAL ELIGIBLE COST

Please give an indicative breakdown of estimated eligible costs of the proposed Action, i.e. the action for which a financial contribution from the TEN-T Programme is requested in this application, by activities (Activities from section A3.1) and year (all amounts are in EUR).

For multi-beneficiary actions, please fill in a table with the global breakdown of the costs and one table per applicant with respective costs per activity. This does not apply to multi-beneficiary actions which have a common financial structure.


A3.4Proposal Nr.

TECHNICAL INFORMATION

Proposed Action

RailwaysCurrent Target

Year Value Year ValueLength of the section (km) Number of tracks Train length Max speed (km/h) Axle load Inclination (deg) Passenger capacity (persons) Passenger traffic flow (pax per year) Freight capacity (t per year) Freight traffic flow (ton-km per year) Rail voltage (V) Clearance or structure gauge Voice system radio Control and command system

RoadsCurrent Target

Year Value Year ValueLength of the section (km) Number of lanes per direction Max speed (km/h) Longitudinal gradient (deg) Vehicles capacity per direction (vehicles/day)

Annual average daily traffic per lane (vehicles/day)

Freight capacity (t per year) Freight traffic flow (ton-km per year) Percentage of heavy good vehicles (%) Road toll (euros/km) Number of fatal accidents Electronic management system (Y/N)

AirportsCurrent Target

Year Value Year ValueNumber of runways Max frequency (movements per hour) Passenger capacity (persons) Passenger traffic flow (pax per year) Freight capacity (t per year) Freight traffic flow (ton-km per year) Max size of aircraft

Electronic management system (which)

Air Traffic ManagementFunctional Airspace Blocks (FABs)

Current TargetYear Value Year Value

Number of FIRs in (proposed) FAB Number ATM systems in use in (proposed) FAB

Number of ATCCs in (proposed) FAB Number of Sectors in (proposed) FAB

PortsCurrent Target

Year Value Year ValueMaster plans (num ports) Master plans (ha) Master plans (t) Breakwaters (km) Breakwaters (m depth at entrance) Dredged fairways and basins (m length) Dredged fairways and basins (m wide) Dredged fairways and basins (m of depth)

Maritime chamber lock (m wide x m long)

Waterway connection (UN class) Waterway connection (t) Rail connection (num tracks) Rail connection (t) Road connection (num lanes) Road connection (t) Port terminals (m draught) Port terminals (m quays) Port terminals (ha) Combined terminals (num rail tracks) Combined terminals (ha) Passenger or cruise terminal (m2) Passenger or cruise terminal (pass) Freight capacity (t per year) Port traffic (num vessels) Electronic management system (which)

Inland WaterwaysCurrent Target

Year Value Year ValueMaster plans (km) Master plans (UN class) Master plans (t) Section (km) Section (reaches) Section (UN class) Navigation reliability (draught) Navigation reliability (days) Navigation reliability (%) IWW locks (num) IWW chamber lock (m wide) IWW chamber lock (m long) Local bottleneck solved (num bridge or others)

11

Ports, transhipment or storage facilities (num)

Ports, transhipment or storage facilities (tons)

Freight capacity (t per year) Freight capacity (ton x km) IWW traffic (vessels) IWW traffic (vessels x km) Electronic management system (which)

Motorways of the Sea(Corresponding component parts relating to the other modes (road, ports, IWW, rail) should be also be filled out for MoS actions)

Current TargetYear Value Year Value

Distance of maritime part of link (nm) Vessels (type: cont or ro/ro) Vessels (type: number) Vessels (capacity: TEU or lm) Traffic volume (t per year) Frequency of departure (e.g.: 1/day) Average vessel turn around time (hours in ports per call)

Duration of action (number of years) Total modal shift (ton/km) Total CO2 emissions Electronic management system (which)

12

Final Notes:

The following fields will provide a drop down list with values (see e-Application form - Part A - Annex for values):

– Priority/Horizontal Project– Section– Transport mode– Member State(s)– Region(s)– ISIC code

13

proposal submission forms · web vieweuropean commission trans-european transport network a1...

Documents