LIFE-Nature 2005 Application Forms, Sections A-C
EUROPEAN COMMISSION
Directorate-General for European Civil Protection and
Humanitarian Aid Operations (ECHO)
ECHO.B - Europe, Eastern Neighbourhood and Middle East
B.1 - Policy Development and Regional Strategy I
GRANT
APPLICATION FORMS
2018 CALL FOR PROPOSALS
Pilot project - Ensuring effective delivery of aid to victims of
sexual and gender-based violence in humanitarian settings
FORMS A and T
NOTE:
Financial Forms are in a separate file.
In a multi-beneficiary grant, it is the responsibility of the
Coordinator to collect and submit all the applicable forms on
behalf of each beneficiary.
FORMS A:
Summary and Administrative Information
Form A0
EUROPEAN COMMISSION
Directorate-General for European Civil Protection and
Humanitarian Aid Operations (ECHO)
ECHO.B - Europe, Eastern Neighbourhood and Middle East
B.1 - Policy Development and Regional Strategy I
Brussels,
DG ECHO, Unit B1
Name of Coordinator:
Contact person:
Postal Address:
Mobile number:
E-mail:
ACKNOWLEDGEMENT OF RECEIPT
Title of the project: ........
Correspondence No. of the project[footnoteRef:2] [2: To be
completed by the Commission]
Sir, Madam,
I acknowledge receipt of your proposal for which I thank
you.
Your proposal will be examined by our services, with respect to
its eligibility. Those proposals declared eligible will then
undergo an evaluation procedure by the Commission.
I will let you know the final decision, as soon as it has been
taken.
Yours faithfully,
Form A1- required for mono-beneficiary and multi-beneficiary
grants
PROJECT
Project title (max. 60 characters):
………………………………………………………………………………………..............................
Project acronym (max. 25 characters):
………………………………………………………………………………..
The project will be implemented in the following country (ies):
…………………………………………………………………………………………………………………
Starting date: ...................... Ending date:
.......................... Duration in months : ……….
COORDINATOR and BENEFICIARIES
Name of beneficiary / coordinator (CO):
...........................................................................................
Below information required only in case of multi-beneficiary
grant
Name of beneficiary (BE1): …………………………………………………………………………………
Name of beneficiary (BE2): …………………………………………………………………………………
Name of beneficiary (BE3): …………………………………………………………………………………
(Continue as necessary)
CO-FINANCIER
Legal name and country of co-financier (same as in Form A6):
affiliated entity
Legal name of the affiliated entity (same as in Forms A4 or A5)
and the beneficiary that it is affiliated to:
(Continue as necessary)
Project Budget and REQuested EC funding
Total project eligible cost: ……………. EUR
EC financial contribution requested: ……………. EUR
Form A2 - required for mono-beneficiary and multi-beneficiary
grants (to be completed by the Coordinator and all
Beneficiaries)
Comments [in grey italics in square brackets] to be deleted
and/or replaced as appropriate by the entity signing the
declaration.
Declaration on honour
Ref: action [insert name/reference];
[insert reference to the call for proposals if applicable]
The undersigned [insert the name of the person signing this
form], representing:
(only for legal persons) the following entity:
Full official name:
Official legal form:
Statutory registration number:
Full official address:
VAT registration number:
declares that the entity:
· is eligible in accordance with the criteria set out in the
specific call for proposals;
· has the required financial and operational capacity as set out
in the specific call for proposals[footnoteRef:3]; [3: This does
not apply to affiliated entities except if their financial capacity
and operational capacity is necessary due to the fact that the
beneficiary composed of these affiliated entities does not have the
required capacity itself.]
· has not received any other Union funding to carry out the
action subject of this grant application and commits to declare
immediately to the Commission/ the Agency any other such Union
funding it would receive until the end of the action.
If any of the above requirements is not satisfied, please
indicate in annex to this declaration which and the name of the
concerned entity with a brief explanation.
I – Situations of exclusion concerning the entity(ies)
· declares that the entity is not in one of the following
situations. If yes, please indicate in annex to this declaration
which situation with a brief explanation.
a) it is bankrupt, subject to insolvency or winding up
procedures, its assets are being administered by a liquidator or by
a court, it is in an arrangement with creditors, its business
activities are suspended or it is in any analogous situation
arising from a similar procedure provided for under national
legislation or regulations;
b) it has been established by a final judgement or a final
administrative decision that it is in breach of its obligations
relating to the payment of taxes or social security contributions
in accordance with the law of the country in which it is
established, with those of the country in which the authorising
officer is located or those of the country of the performance of
the contract;
c) it has been established by a final judgement or a final
administrative decision that it is guilty of grave professional
misconduct by having violated applicable laws or regulations or
ethical standards of the profession to which the entity belongs, or
by having engaged in any wrongful conduct which has an impact on
its professional credibity where such conduct denotes wrongful
intent or gross negligence, including, in particular, any of the
following:
(i) fraudulently or negligently misrepresenting information
required for the verification of the absence of grounds for
exclusion or the fulfilment of selection criteria or in the
performance of a contract, a grant agreement or a grant
decision;
(ii) entering into agreement with other persons with the aim of
distorting competition;
(iii) violating intellectual property rights;
(iv) attempting to influence the decision-making process of the
Commission/ the Agency during the award procedure;
(v) attempting to obtain confidential information that may
confer upon it undue advantages in the award procedure;
d) it has been established by a final judgement that it is
guilty of the following:
(i) fraud, within the meaning of Article 1 of the Convention on
the protection of the European Communities' financial interests,
drawn up by the Council Act of 26 July 1995;
(ii) corruption, as defined in Article 3 of the Convention on
the fight against corruption involving officials of the European
Communities or officials of EU Member States, drawn up by the
Council Act of 26 May 1997, and in Article 2(1) of Council
Framework Decision 2003/568/JHA, as well as corruption as defined
in the legal provisions of the country where the authorising
officer is located, the country in which the entity is established
or the country of the performance of the contract;
(iii) participation in a criminal organisation, as defined in
Article 2 of Council Framework Decision 2008/841/JHA;
(iv) money laundering or terrorist financing, as defined in
Article 1 of Directive 2005/60/EC of the European Parliament and of
the Council;
(v) terrorist-related offences or offences linked to terrorist
activities, as defined in Articles 1 and 3 of Council Framework
Decision 2002/475/JHA, respectively, or inciting, aiding, abetting
or attempting to commit such offences, as referred to in Article 4
of that Decision;
(vi) child labour or other forms of trafficking in human beings
as defined in Article 2 of Directive 2011/36/EU of the European
Parliament and of the Council;
e) it has shown significant deficiencies in complying with the
main obligations in the performance of a contract, a grant
agreement or a grant decision financed by the Union’s budget, which
has led to its early termination or to the application of
liquidated damages or other contractual penalties, or which has
been discovered following checks, audits or investigations by an
Authorising Officer, OLAF or the Court of Auditors;
f) it has been established by a final judgment or final
administrative decision that it has committed an irregularity
within the meaning of Article 1(2) of Council Regulation (EC,
Euratom) No 2988/95;
g) for the situations of grave professional misconduct, fraud,
corruption, other criminal offences, significant deficiencies in
the performance of the contract or irregularity, it is subject
to:
i. facts established in the context of audits or investigations
carried out by the Court of Auditors, OLAF or internal audit, or
any other check, audit or control performed under the
responsibility of an authorising officer of an EU institution, of a
European office or of an EU agency or body;
ii. non-final administrative decisions which may include
disciplinary measures taken by the competent supervisory body
responsible for the verification of the application of standards of
professional ethics;
iii. decisions of the ECB, the EIB, the European Investment Fund
or international organisations;
iv. decisions of the Commission relating to the infringement of
the Union's competition rules or of a national competent authority
relating to the infringement of Union or national competition
law;
v. decisions of exclusion by an authorising officer of an EU
institution, of a European office or of an EU agency or body.
II – Situations of exclusion concerning natural persons with
power of representation, decision-making or control over the
entity(ies)
This section applies only to declarations by legal persons, with
the exception of Member States and local authorities
· declares that, for the entity subject to this declaration, (a)
natural person(s) who is/are member(s) of the administrative,
management or supervisory body(ies) or who has/have powers of
representation, decision or control (this covers company directors,
members of management or supervisory bodies, and cases where one
person holds a majority of shares) is/are not in one of the
following situations. If yes, please indicate in annex to this
declaration which situation and the name(s) of the concerned
person(s) and entity(ies) with a brief explanation.
- situation (c) above (grave professional misconduct)
- situation (d) above (fraud, corruption or other criminal
offence)
- situation (e) above (significant deficiencies in performance
of a contract)
- situation (f) above (irregularity)
III – Situations of exclusion concerning natural or legal
persons assuming unlimited liability for the debts of the
entity(ies)
This section applies only to declarations that include an entity
for which a natural or legal person assumes unlimited liability for
debts
· declares that (a) natural or legal person(s) that assume(s)
unlimited liability for the debts of the entity(ies) subject to
this declaration is/are not in one of the following situations. If
yes, please indicate in annex to this declaration which situation
and the name(s) of the concerned person(s) and entity(ies) with a
brief explanation .
- situation (a) above (bankruptcy)
- situation (b) above (breach in payment of taxes or social
security contributions)
IV – Remedial measures
If for the entity subject to this declaration it has been
declared that it is in one of the situations of exclusion listed
above, an annex to this declaration must indicate the measures the
entity has taken to remedy the exclusion situation, thus
demonstrating its reliability. This may include e.g. technical,
organisational and personnel measures to prevent further
occurrence, compensation of damage or payment of fines. The annex
must include relevant documentary evidence which illustrates the
remedial measures taken. Remedial measures cannot be proposed for
situations referred in point (d).
V – Evidence upon request
The Commission may request the entity subject to this
declaration to provide information and the applicable evidence on
any person that is member of an administrative, management or
supervisory body (persons with powers of representation, decision
or control with regard to that entity).
The Commission may request the entity subject to this
declaration to provide the applicable evidence concerning the
entity itself and / or concerning the natural or legal persons
which assume unlimited liability for the debts of the entity.
Evidence may be requested as follows:
For situations described in (a), (c), (d) or (f), production of
a recent extract from the judicial record is required or, failing
that, an equivalent document recently issued by a judicial or
administrative authority in the country of establishment of the
entity showing that those requirements are satisfied.
For the situation described in point (a) or (b), production of
recent certificates 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
entity is liable, including for example, VAT, income tax (natural
persons only), company tax (legal persons only) and social security
contributions. Where any document described above is not issued in
the country concerned, it may be replaced by a sworn statement made
before a judicial authority or notary or, failing that, a solemn
statement made before an administrative authority or a qualified
professional body in its country of establishment.
If an entity has already submitted such evidence for the purpose
of another procedure and provided that the submitted documents are
still valid and that the time that has elapsed since the issuing
date of the documents does not exceed one year, the entity shall
declare on its honour that the documentary evidence has already
been provided and confirm that no changes have occurred in its
situation.
If selected to be awarded a grant, the entity subject to this
declaration accept the terms and conditions laid down in the grant
agreement.
The entity subject to this declaration may be subject to
rejection from this procedure and to administrative sanctions
(exclusion or financial penalty) if any of the declarations or
information provided as a condition for participating in this
procedure prove to be false.
Full nameDateSignature
Form A3 – required for multi-beneficiary grants only
Partnership statement (to be signed by the Coordinator and all
Beneficiaries)
A partnership is a relationship, involving shared
responsibilities, between two or more entities for the purpose of
implementing an Action funded by the European Union, represented by
the European Commission. To ensure that the Action runs smoothly,
the Commission thus requires the below outlined good partnership
principles to be acknowledged and upheld.
I, [LAST NAME, Name of the signatory of the statement], on
behalf of
[Full official name of the entity]
[Official legal form of the entity]
[Full official address of the entity]
[VAT registration number of the entity]
declare to have read and approved the content of the proposal
entitled [insert title of the proposal] submitted for funding to
the Commission and I undertake to comply with the following
principles of good partnership:
1. The coordinator and the beneficiaries have read the Guide for
Applicants and the Grant Application Forms and understand the
purposes and expected results of the Call for proposals.
Furthermore, the coordinator and the beneficiaries understand their
role in the Action before the submission of the application to the
European Commission. They commit to comply with the relevant
eligibility criteria, as defined in the Call for proposals.
2. The coordinator and the beneficiaries have read the
applicable Grant Agreement and understand their respective
obligations under the Grant Agreement. The beneficiaries authorise
the coordinator to sign the Grant Agreement with the Commission on
their behalf and to represent them in all dealings with the
Commission in the context of the implementation of the Action.
3. The coordinator consults other beneficiaries regularly
concerning the different aspects of the implementation of the
Action and keeps them fully informed.
4. The beneficiaries receive copies of reports - narrative and
financial – prepared for and submitted to the Commission.
5. Any requests for amendments to the agreement (e.g. changes to
the activities presented in Annex I to the Agreement, beneficiaries
etc.) are agreed by the coordinator and beneficiaries prior to
submission to the Commission. Where no such agreement can be
reached and the request is nonetheless submitted to the Commission
the absence of agreement is to be mentioned in the request.
Name
Position
Title of the Project
Date and place
Signature
Form A4 – required for mono-beneficiary and multi-beneficiary
grants
COORDINATOR PROFILE
Coordinator Profile Information
Short Name
Participant ref.
CO
Legal information on the Coordinator
Legal Name *
Legal Status
VAT No
Public
Private
Natural person
Legal Registration No
Registration Date
* The legal name is the name under which the participant(s)
is/are registered in the official trade register
International organisation
Legal address of the Coordinator
Street Name and No
PO Box
Post Code
Town/City
Country Code
Country Name
Coordinator contact person information
Title
Function
Surname
First Name
Department / Service Name
Street Name and No
PO Box
Post Code
Town/City
Country
Telephone No
Fax No
E-mail
Website
Coordinator details
Number of employees
Number of employees in department conducting project
Is Your Organisation independent (Yes or No)
If No, please indicate legal name(s) of owner(s) who own 25 % or
more
Is there an entity affiliated to you taking part in the project?
(Yes or No)[footnoteRef:4] [4: Please answer in line with the
conditions outlined in the call for proposals for an entity to be
considered as an affiliated entity (Chapters 5 and 16).]
If Yes, please indicate the name(s) of the affiliated entity
(ies) and the nature of the structural link.[footnoteRef:5] [5:
Please support your answer by reference to official documents
establishing the affiliated entity (ies); an extract from said
documents must be attached to this form. ]
Brief description of the structure and the activities of the
Coordinator
Form A5 - required for multi-beneficiary grants only
BENEFICIARY PROFILE (one separate form per Beneficiary)
Beneficiary Profile Information
Short Name
Participant ref.
BE…
Legal information on the Beneficiary
Legal Name*
Legal Status
VAT No
Public
Private
Natural person
Legal Registration No
Registration Date
* The legal name is the name under which the participant(s)
is/are registered in the official trade register
International organisation
Legal address of the Beneficiary
Street Name and No
PO Box
Post Code
Town/City
Country Code
Country Name
Beneficiary contact person information
Title
Function
Surname
First Name
Department / Service Name
Street Name and No
PO Box
Post Code
Town/City
Country
Telephone No
Fax No
E-mail
Website
Beneficiary details
Annual turnover
Last Financial Year
Number of employees
Number of employees in department conducting project
Is Your Organisation independent (Yes or No)
If No, please indicate legal name(s) of owner(s) who own 25 % or
more
Is there an entity affiliated to you taking part in the project?
(Yes or No)[footnoteRef:6] [6: Please answer in line with the
conditions outlined in the call for proposals for an entity to be
considered as an affiliated entity (Chapters 5 and 16).]
If Yes, please indicate the name(s) of the affiliated
entity(ies) and the nature of the structural link[footnoteRef:7]
[7: Please support your answer by reference to official documents
establishing the affiliated entity (ies); an extract from said
official documents must be attached to this form.]
Brief description of the structure and the activities of the
Beneficiary
Form A6
CO-FINANCIER PROFILE AND COMMITMENT (one separate form per each
co-financier)*
Legal Name and full address on the co-financier
Financial commitment
We will contribute the following amount to the project:
….. €
Status of the financial commitment
Stamp and signature of the authorised person
Name and status of the authorised person (obligatory):
Date of the signature
(obligatory):
Signature (obligatory):
* If the project includes co-financers other than the European
Commission, this form is compulsory. Complete one form per
co-financer (A6/1, A6/2, A6/3, etc.)
Remember that the amounts in Form(s) A6 must be consistent with
the amounts indicated in the financial forms F0 and F1.
Form A7 – required for mono-beneficiary and multi-beneficiary
grants
OTHER PROPOSALS SUBMITTED FOR EUROPEAN UNION FUNDING
Please answer each of the following questions:
Have you or any of the beneficiaries already benefited from
previous co-financing under any EU civil protection financial
instruments or programmes? (Title, year, amount of the co-financing
and duration)
Have you or any of the beneficiaries already benefited from
previous European Union financing (grants, procurements or loans)
for activities that may relate to the present proposal? (title,
year, amount of financing and duration)
Have you or any of the beneficiaries applied for European Union
funding under any other financial instruments for actions which
form part of or are directly related to this proposal? With what
results? Please give full details!
Form A8 – required for mono-beneficiary and multi-beneficiary
grants (to be completed by the Coordinator and all
Beneficiaries)
Template of Legal Entities Form
The Legal Entity form specifically adapted to the legal status
of the Coordinator (public entity or private company) as well as to
the country/ language is available on
http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm
ATTENTION/ The document below is only an example. Please use the
appropriate document available from the above link.
Form A9 – required for mono-beneficiary and multi-beneficiary
grants (only Coordinator to complete)
Template of Financial Identification Form
The financial identification form specifically adapted to the
country/ language of the bank account is available on
http://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm
SECTION T:
Objective, actions and expected results
Project planning and structure
Form T1 – required for mono-beneficiary and multi-beneficiary
grants
SUMMARY OF THE PROJECT (Maximum 15 pages)
Title
Narrative summary (maximum 400 words)
Describe the general and specific objectives that the project
aims to achieve
Describe the main activities planned and where it will be
implemented (in order to implement the objectives)
Describe the methodology (including time-table and
monitoring)
Expected results and concrete outputs
Dissemination strategy
Subcontracting
Please provide a list of all the tasks that will be
subcontracted, including the information on the relevant provider
and procedure. Having regard to the nature of the action and what
is necessary for its implementation, explain as well the
added-value of the subcontracting (information to be in line with
the information provided in estimated budget form). Please list the
subcontracts here, and under task in form T3 list the details of
the relevant sub-contracting.
Form T2 – required for mono-beneficiary and multi-beneficiary
grants
Project Acronym
Task ID
Task Title
Start Date
End Date
Actions
Deliverables
(Maximum number of tasks – 10)
Form T3a – required for mono-beneficiary and multi-beneficiary
grants
Project Acronym
T3a - Task Form
Task ID
Task Title
Objectives
DESCRIPTION
Action A.1
Name of the action:
Description (what, how and where):
Expected results:
Constraints and assumptions:
Responsible for implementing it:
Action will be subcontracted:Yes/No/Partially
Action A.2
Name of the action:
Description (what, how and where):
Expected results:
Constraints and assumptions:
Responsible for implementing it:
Action will be subcontracted:Yes/No/Partially
Etc.
Form T3b – required for mono-beneficiary and multi-beneficiary
grants
Project Acronym
T3b- Task Form
Page 1 of maximum 10 (1 task per page)
Task ID
Task Title
Start Date
End Date
Duration
Deliverable Date
Deliverable Description
