ROMANIAN GOVERNMENTMINISTRY OF TRANSPORTS

FINANCING APPLICATION FORM

SECTORAL OPERATIONAL PROGRAMME - TRANSPORT

2007 – 2013

PRIORITY AXIS 1, 2, 3

APPLICATION CONTENTA. Applicant InformationB. Project DescriptionC. Project ContextD. Project MaturityE. Feasibility StudyF. Cost – benefit analysisG. Environment Impact AssessmentH. Justification for the public contributionI. Financing planJ. Anexes

REGISTRATION OF THE FINANCING APPLICATION1

Managing Authority – General Directorate for Foreign Financial AffairsDate of registration: Name of the person who made the

registration:

Number of registration: Signature:

A. APPLICANT INFORMATION

1. Name of the applicant2: ............................................

2. Fiscal code: ..........................................................

3. Fiscal Identification Number: ........................................

4. Number of the Association and Foundation Registry (where applicable): .......................

5. Address: .......................................................

6. Type of the applicant:

public juridical entity3

private juridical entity

private juridical entity of public utility

7. Value Added Tax

Does the applicant organisation pay the VAT?

Yes No

Do you have activities in the project for which you apply for the financing, to this request, for which the applicant organisation is paying VAT?

Yes No

If the organisation is paying VAT for the whole activity, or only for project activities to be done, please, indicate the VAT code.

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

8. The Year of the entity foundation (only for trading companies and independent administration)

9. Applicant situation (only for trading companies and independent administration)

1 To be fill in by the Managing Authority2The Applicant could be an individual juridical entity or an association of juridical entities for managing the project .3 Government insitutions, public institutions, territorial-administrative units, commercial societies with majority capital.

2

Year n4-1 Year n - 2 Year n - 3Number of employeesBusiness figuresBalance sheet profit

10. Legal representative5:

Name :Position:Telephone:Fax:E-mail:

11. Contact person:

Name :Position:Telephone:Fax:E-mail

12. Bank:

Bank/branch office:Address:Cod IBAN:

13. Previous experience in managing projects financed from the public funds

Have you previously benefited of non reimbursable assistance from public funds (EU funds included) or of loan from IFI for the last 5 years?

Yes No

If yes, please specify the following information for the maximum 5 projects (the projects will be presented starting with the recently approved project through the signing a memorandum/agreement/financing(loan) contract):

o Title of project and the reference number (where applicable)

o Project implementation stage (maximum 10 lines) :

o Project total value (in euro):

o Source/ financing sources:

4 „n” – the year of registration the present application5 If the person who signed this application is different from the legal representative of the applicant, he must have a legal empowerment.

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14. Project management6

The project management structure

Please, present the organisational structure which will be responsible with the project management, showing how the functions separation is assured in order to avoid any potential conflict of interest.

In addition, please specify if the structure responsible with the project management have proper procedures for this scope and how the audit trial will be assured.

Human resources involved in managing the project.

The estimative number of personnel involved in managing the project, key- personnel qualification and professional experience, information regarding the source of the personnel remuneration

Project material resources.

The space for the administrative activities (including the project documents archiving) , the equipment, the access to utilities and communications, informatic systems (including information regarding to accountancy system, which has to ensure a distinct accountant evidence of project)

B. PROJECT DESCRIPTION

6 If the project implementation will be implemented by another entity than the Applicant, it must be mentioned the respective structure and provide details about how the Beneficiary will ensure the achievement of the project objectives.

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15. Title of the project: ..................................................................................................

16. Introducing the project in the Sectoral Operational Programme – Transport

Select the priority axis and the major key area of intervention for which the project is proposed to be financed.

Priority axis 1 - Modernization and development of TEN-T priority axes aiming at sustainable transport system integrated with EU transport networks

Key areas of intervention 1 - Modernization and development of road

infrastructure along the TEN-T priority axis 7

Key areas of intervention 2 - Modernization and development of railway infrastructure along the TEN-T priority axis 22

Key areas of intervention 3 - Modernization and development of water transport infrastructure along the TEN-T priority axis 18

Priority axis 2 - Modernization and development of the national transport infrastructure outside the TEN-T priority axes aiming at sustainable national transport system

Key areas of intervention 1 – Modernization and development of the national road infrastructure

Key areas of intervention 2 - Modernization and development of the national rail infrastructure

Key areas of intervention 3 – Modernization and development of the Danube and maritime ports

Key areas of intervention 4 – Modernization and development of the air transport infrastructure

Priority axis 3 - Modernization of transport sector aiming at higher degree of environmental protection, human health and passenger safety

Key areas of intervention 1 - Promote inter-modal transport

Key areas of intervention 2 - Improve traffic safety across all transport modes

Key areas of intervention 3 - Minimize adverse effects of transport on the environment

Structural Instruments for co-financing the project

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Cohesion Fund (CF)

European Regional Development Fund (ERDF)

17. TYPE OF THE PROJECT

technical assistance for preparing the projects

investments with a total estimated value higher or equal to 50 mil.EUR (major projects)7

investments with a total estimated value to less than 50 mil. EUR8

18. Project location

o County /counties………………

19. Project objectives

Please, detail the project objectives9 and its contribution to achieve the specific objectives of the priority axis and finally the general objective of POS – T.

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

In case of projects with an eligible value more than 20 mil EUR (inclusive), please detail the following aspects: Present situation of the infrastructure and the project impact

Socio-economic objectives

20. Project category10

21. Technical description of the project

Describe the main activities of the project and, provide details of its main components and characteristics elements of the investment infrastructure project.(eg. construction the highway, modernization of the national road, construction/ modernization of the railway, railway station, modernization/extend ports/airports etc.) ........................................................................................................................................

7 The rate exchange for EUR is the latest related to the European Central Bank published on the last day of the previous month for preparing this financing application.8 The rate exchange for EUR is the latest related to the European Central Bank published on the last day of the previous month for preparing this financing application.9 The objectives should be established so as they could be measured with a set of indicators.10 Provide reference if the project is a phase to a complex operation and criteria used to determine the operation phases, as the fact that these phases are independent from technical and financial point of view.

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For each of the activities/ works mentioned above, please identify and quantify the key output indicators to be used11.

Although, please indicate the source and modality to determine the value of indicators.

INDICATORS Value of the indicator at the beginning of the implementation

Value of the indicator at the end of the implementation

Immediate results12

Impact results13

Identify the main beneficiaries of the infrastructure (target population served, quantified where possible)

........................................................................................................................................Decribe the project respect the principle of „equal chances”.

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

If the construction of the infrastructure to be delivered is a public-private partnership (PPP), describe the form of the PPP (i.e., selection process for private partner, structure of PPP, infrastructure ownership arrangements, risk allocation arrangements, etc.): In addition, please give details of how the infrastructure is to be managed after the project is completed (i.e., public management, concession, other form of PPP)

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

22. Timetable for the development of the overall project

Activity14 Start date Completion dateFeasibility studies: dd/mm/yyyy dd/mm/yyyyCost-benefit analysis dd/mm/yyyy dd/mm/yyyyEnvironmental impact assessment dd/mm/yyyy dd/mm/yyyyDesign studies dd/mm/yyyy dd/mm/yyyyLand acquisition dd/mm/yyyy dd/mm/yyyyPreparation of Tender documentation dd/mm/yyyy dd/mm/yyyyTender procedure(s) dd/mm/yyyy dd/mm/yyyyConstruction phase dd/mm/yyyy dd/mm/yyyyOperational phase dd/mm/yyyy dd/mm/yyyyDuration of the overall project (months)

11 The indicators should be correlated with those presented in the Framework Implementing Document.12 Immediate results from the project implementation (eg. X km of highway, X km of railway, X trained persons etc.) 13 Impact results from project targets objectives (eg. reducing with X hours the time of movement from A to B, reducing with X % the number of accidents, improving the administrative capacity etc.)14 Presented activities are examples. The applicant will detail the activities timetable related to described activities at 21.1 Section.

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23. The procurement plan

Nr. Contract/framework agreement objective

Estimated value15

(lei)

Apllied procedure

Estimated date to

start the procedure

Estimated date to

finalise the procedure

Official Journal of EC16

zz/ll/aaaa zz/ll/aaaa

24. Information and Publicity

Give details of the proposed measures to ensure the publicity of the Community assistance for the project:

Information and publicity activity

Estimated duration/period Estimated costs

Outdoor publicityPress releaseOnline publicityAudio-video...............................

C. PROJECT CONTEXT

25. Relation with other programmes/strategies/projects

Name Relation descriptionProgrammeStrategyProjectOther relevant document –national level/regional

26. Financing assistance for project

Has an application been made for assistance from any other Community source for this project?

Yes No

If yes, please detail the following information:

o Programme Title

o Project Title and reference number (where applicable)

o Financing source/sources

15 For the procurement procedures contracted before the date of this registration it will presented the real value , not the estimated value. 16 In case of publishing the procurement notice in the EC Official Journal, plpresent the reference number.

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Is this project complementary to any project already financed or to be financed by the ERDF, ESF, Cohesion Fund, TEN-T Budget, other source of Community finance?

Yes No

If yes, give detail the following information:

o Programme Title

o Project Title and reference number (where applicable)

o Financing source/sources

JASPERS Contribution

Has JASPERS technical assistance contributed to any part of the preparation of this project?

Yes No

If Yes, please describe the elements of the project where JASPERS had an input.

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

Provide the principal conclusions and recommendations of the JASPERS contribution and which of these were taken into account in the finalisation of the project.

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

D. PROJECT MATURITY17

27. Technical stage18

feasibility…………………………………………………………

design studies:……………………………………………………………………

others(detail): ....................................................................................

28. Administrative stage19

planning certificate:………………………………………………………………

environmental permit:…………………………………………………………………

land purchase: ................................................

building permit:…………………………………

17 Section D will be filled only for investments projects , no matter of their estimated total value18 Indicate the finalised stages with relevant details (finalisation date, references and documents)19 Indicate the finalised stages with relevant details (finalisation date, references and documents)

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Expected date for tendering:……………………………………………………

others (detail): ....................................................................................

29. Financing resources 20Have any budgetary arrangements been made for financing the project?

Yes No

Please, mention if:

Has a normative act already been promoted for the approval of the project technical economic indicators, of the total estimated value and of the financing resources?

Has a loan agreement already been signed for (co) financing the project?

Has an agreement been made regarding a commercial credit for co financing the project (comfort letter)?

others (detail): ...................................................................................

30. If the project has already started, indicate the current state of works:

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

E. RESULTS OF FEASIBILITY STUDIES 21

31. Transport demand analysis

Provide a summary of the demand analysis, including the predicted utilisation rate on completion and the demand growth rate.

32. Options considered

Outline the alternative options considered in the feasibility studies.

33. Provide a summary of the main conclusions of the feasibility studies conducted

The selected alternative and the reasons for which it has been selected.Technical solutions(where applicable)Environmental impact

20 Please have in view the SOPT financing principle is based on the reimbursable expenditure. Therefore, the funds necessary for financing the project have to be covered from the existing budgetary commitments before the signature of the financing contract.21 Section E will be filled in only for investment projects, no matter of their estimated total value.

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34. Financing the feasibility studies22.

Give precise references if ERDF, Cohesion Fund, ISPA or other Community assistance is/was involved in the financing of the feasibility studies.

F. COST-BENEFIT ANALYSIS 23

This section should be based on the Guidelines on the methodology for carrying out the cost-benefit-analysis of major projects.

35. Financial analysis

Please mention if the project is estimated to generate revenues, please mention.

Yes – continue section No.35

No – continue with section No. 36

Short description of methodology and specific assumptions made

Main elements and parameters used for financial analysis

Elements and parameters Value Not discounted

ValueDiscounted (Net Present

Value)LEI EUR LEI EUR

1 Reference period (years)

2 Financial discount rate (%)

3 Total investment cost

4 Total investment cost

5 Residual value

6 Residual value

7 Revenues

8 Operating costs

9 Net revenue = revenues – operating costs + residual value = (7) – (8) + (6)

10 Eligible expenditure = investment cost – net

22 Information will be correlated with the above presented information at Section 25 of this application.23 Section F will be fill in only for investment projects, no matter of their estimated total value.

11

revenue = (4) – (9)

11 Funding gap rate (%) = (10) / (4)

* The costs and revenues should be based on figures excluding VAT Main results of the financial analysis

Without Community assistance

With Community assistance

Financial rate of returnNet present value

Revenues generated over its lifetime

If the project is expected to generate revenues through tariffs or charges borne by users, please give details of charges

Do the charges cover the operational costs and depreciation of the project?

Do the charges differ between the various users of the infrastructure?

Are the charges proportional to the use of the project? Are the charges proportional to the pollution generated by users

......................................................................................................................................If no tariffs or charges are proposed, how will operating and maintenance costs be covered? (give references)

36. Socio-economic analysis

Provide a short description of methodology (key assumptions made in valuing costs and benefits) and the main findings of the socio-economic analysis:

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

Give details of main economic costs and benefits identified in the analysis together with values assigned to them:

BenefitUnit value (where

applicable)

Total value(in euro,

discounted)% of total

benefits

LEI EUR LEI EUR

.....

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Total 100Cost Unit value (where

applicable)Total value

% of total costs

LEI EUR LEI EUR.....

Total 100

Main indicators of the economic analysis

Indicators Values1. Social discount rate (%)

2. Economic rate of return (%)

3. Economic net present value (in euro)

4. Benefit-cost ratio

Employment effects of project

Provide an indication of the number of jobs to be created (expressed in terms of full-time equivalents (FTE))

Number of jobs directly created

No (FTE) Average duration of these jobs (months)

1. During implementation phase

2. During operational phase

Identify the main non-quantifiable / non valuable benefits and costs:

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

37. Risk and sensitivity analysis

Short description of methodology and summary results

Sensitivity analysis

State the percentage change applied to the variables tested: ……………….

Present the estimated effect on results of financial and economic performance indexes.

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Variable tested Financial Rate of Return variation

Financial Net Present Value variation

Economic Rate of Return variation

Economic Net Present Value variation

Which variables were identified as critical variables? State which criterion is applied.

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

Which are the switching values of the critical variables?

......................................................................................................................................Risk analysis

Describe the probability distribution estimate of the project’s financial and economic performance indexes. Provide relevant statistical information (expected values, standard deviation)

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

G. ANALYSIS OF THE ENVIRONMENTAL IMPACT24

38. How does the project:

a) contribute to the objective of environmental sustainability (European climate change policy, halting loss of biodiversity, other …)

b) respect the principles of preventive action and that environmental damage should as a priority be rectified at source

c) respect the "polluter pays" principle

39. Consultation of environmental authorities

Have the environmental authorities likely to be concerned by the project been consulted by reason of their specific responsibilities?

Yes No

If yes, please give name(s) and address(es) and explain that authority's responsibility If no, please give reasons

24 Section G will be filled in only for investment projects, independent of their value

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40. Environmental Impact Assessment

Environmental Permit

Has the environmental permit been already issued for this project?

Yes No

If yes, on which date: dd/mm/yyyy

If no, when was the environmental permit formally requested?

By which date is the final decision expected?

Specify the competent authority or authorities which have issued or will issue the environmental permit.

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

APPLICATION OF COUNCIL DIRECTIVE 85/337/EEC ON ENVIRONMENTAL IMPACT ASSESSMENT (EIA)

Is the project a class of development covered by:

Annex I of the Directive (go to question 40.2.2)

Annex II of the Directive (go to question 40.2.3)

Neither of the two annexes (go to question 40.3)

When covered by Annex I of the Directive, include the following documents:

the information referred to in Article 9 (1) of the Directive the non-technical summary of the Environmental Impact Study

carried out for the project; information on consultations with environmental authorities, the

public concerned and, if applicable, with other Member States.

When covered by Annex II of the Directive, has an Environmental Impact Assessment been carried out for this project?

Yes

(in this case, include the necessary documents listed above)

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No (in this case, explain the reasons, criteria etc. considered to reach the conclusion that the project has no significant environmental effects):

APPLICATION OF THE STRATEGIC ENVIRONMENTAL ASSESSMENT DIRECTIVE 2001/42/EC (SEA-Directive)

Does the project result from a plan or programme falling within the scope of the SEA Directive?

NO - in which case please provide a short explanation

...................................................................................................................................... YES - in which case, in order to appreciate if wider potential cumulative effects of the project have been addressed, please provide a copy of the non- technical summary from the Environmental Report carried out for the plan or programme.

ASSESSMENT OF EFFECTS ON NATURA 2000 SITES

Is the project likely to have significant negative effects on sites included or intended to be included in the NATURA 2000 network?

Yes, in which casePlease provide a summary of the conclusions of the appropriate assessment carried out according to Article 6 (3) of Directive 92/43/EEC

In case, compensation measures were deemed necessary according to Article 6 (4), please provide a copy of the form “Information on projects likely to have significant negative effect on NATURA 2000 sites, as notified to the Commission (DG Environment) under Directive 92/43/EEC.

No, in which case attach a completed Annex I declaration filled in by the relevant authority.

Additional environmental integration measures

Does the project envisage, apart from Environmental Impact Assessment, any additional environmental integration measures (e.g. environmental audit, environmental management, specific environmental monitoring) ?

If yes, specify

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

No

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Cost of measures taken for correcting negative environmental impacts .If included in total cost, estimate proportion of cost of measures taken to reduce and/or to compensate for negative environmental impacts

G.JUSTIFICATION FOR THE PUBLIC CONTRIBUTION

41. Competition

Does this project involve State Aids?

Yes No

If yes, please give in the table below the necessary information :

Sources of aid (local, regional, national and

Community):

Amountof aid

LEI/EUR

State Aid number/ registry number for

block-exempted

Reference of approval letter

Approved aid schemes, approved ad hoc aid, or aid falling under a block exemption regulation ::

..... .....

Aid foreseen under pending notifications (ad hoc aid or schemes) :

..... .....

Aid for which a notification is outstanding (ad hoc aid or schemes)

..... .....

Total aid grantedTotal cost of theinvestment project

42. Impact of Community assistance on project implementation

Will Community assistance accelerate implementation of the project?

Yes No

If yes, explain in what way

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Will Community assistance be essential to implementation of the project?

Yes No

If yes, explain in what way

H. FINANCING PLAN 43..Cost breakdown

Nr Category Total cost of the project

(A)

Non-eligible expenditures

(B)25

Eligible expenditures

(C)1 Planning/design fees2 Land purchase3 Building and construction4 Plant and machinery5 Contingencies26

6 Technical assistance7 Publicity8 Supervision during

construction implementation9 Others(detail)10 Sub-total11 TVA12 Total

44. Financing resourcesEuropene Community contribution

Nr Value1 Eligible cost (in euro, not discounted)

(Section 43,row 11, column C)2 Funding gap rate (%) Section 35.3, row 11) 3 Eligible public contribution 4 Co-financing rate of the priority axis (%)5 Community contribution = (3)*(4)6 Eligible private contribution (if applicable)

25 The non-eligible expenditures are those which are not included in the MEF-MT Order no. 75/28/2008.26 Contingencies should not exceed 10% of the total investment net cost.

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Sources of co-financing

Total eligible costs Total non-eligible costsTotal cost

Public contribution

European Commission contribution

National public contribution27

National private

contribution28

Other sources

Out of which (informative)

loans BEI/FEI

National public

contribution29

National private

contribution30

Other sources:

Out of which (informative) loans BEI/FEI

a=b+e+f b=c+d c d e f g h i j k

27 If it is the case of in kind contribution, the applicant will provide information related to this issue, in accordance with the provisions of the GoD nr. 759/2007 and of the MEF-MT Order no. 75/28/2008.28 If it is the case of in kind contribution, the applicant will provide information related to this issue, in accordance with the provisions of the GoD nr. 759/2007 and of the MEF-MT Order no. 75/28/2008.29 If it is the case of in kind contribution, the applicant will provide information related to this issue, in accordance with the provisions of the GoD nr. 759/2007 and of the MEF-MT Order no. 75/28/2008.30 If it is the case of in kind contribution, the applicant will provide information related to this issue, in accordance with the provisions of the GoD nr. 759/2007 and of the MEF-MT Order no. 75/28/2008.

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Expenditures Plan

Please fill in the following information regarding to the eligible and non-eligible expenditures forecasting which will be made in the project.

2007 2008 2009 2010 2011 2012 2013 2014 2015Total expendituresEligible expenditures, from:Eligible public expenditures Eligible private expendituresNon-eligible expenditures

Annual allocation of the eligible public contribution

2007 2008 2009 2010 2011 2012 2013Eligible financing from public funds, from:European Commission ContributionNational public contribution

ENDORSEMENT OF COMPETENT NATIONAL AUTHORITYI confirm that the information presented in this form is accurate and correct.

NAME:

SIGNATURE:

ORGANISATION (applicant)

DATE:

I. ANEXES

No Document Applicable (yes/no)1 Legal copy of the constitutive document2 Legal copy of the registration certificate from The

Commerce Registry3 Legal copy of the fiscal registration certificate 4 Copies ( the original conformity) for the official balance

sheet for the last 3 years (only for trade societies and autonomous administration)

5 Documents for certifying that the applicant does not have debits to the state budget, released from the Financial Administration (only for trade societies and autonomous administration)

6 Applicant rap sheet 7 Documents to prove the co financing 8 Association Agreement (in case that the applicant is a

group or juridical entities)9 Feasibility studies

10 Cost Benefit Analysis11 Environmental Impact. Assessment Study12 Environmental permit or planning certificate and other

permits/authorizations obtained13 Business plan 14 Organisational chart with the number of personnel

responsible for the project management 15 The CV s of the key personnel involved in the project

management

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