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Part B. Full Application Form
The European Union represented by the European Commission
Support to Ukraine's regional development policy
Grant Application Form
Budget line: 19.080103
Reference:EuropeAid/134171/LACT/UA
Deadline for submission of concept notes: 1 July 2013
To reduce expense and waste, we strongly recommend that you use only paper for your file (no plastic folders or dividers). Please also use double-sided printing if possible
| Title of the action: | |
| [Number and title of lot] | |
| Location(s) of the action: | <specify country(ies), region(s), area(s) or town(s) that will benefit from the Action> |
| Name of the applicant | |
| Nationality of the applicant[1] |
| Dossier No | |
| (for official use only) |
| EuropeAid ID[2] | |
| Ongoing contract/Legal Entity File Number (if available)[3] | |
| Legal status[4] | |
| Co-applicant [5] | Name; EuropeAid ID; Nationality and date of establishment; Legal status; Relation with the applicant or co-applicant |
| Affiliated entity[6] | Name; EuropeAid ID; Nationality and date of establishment; Legal status; Relation with the applicant or co-applicant |
| Applicant’s contact details for the purpose of this action | |
| Postal address: | |
| Telephone number: (fixed and mobile) Country code + city code + number | |
| Fax number: Country code + city code + number | |
| Contact person for this action: | |
| Contact person’s email: | |
| Address: | |
| Website of the Organisation: |
Any change in the addresses, phone numbers, fax numbers or e-mail, must be notified in writing to the Contracting Authority. The Contracting Authority will not be held responsible in the event that it cannot contact an applicant.
NOTICE
When processing your application, any personal data (e.g. names, addresses and CVs), will be recorded and processed if necessary in accordance with 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 otherwise specified, your replies to the questions and any personal data are required only to evaluate your proposal in accordance with the Guidelines for the call for proposal and will be processed solely for that purpose by the data controller. Details concerning processing of your personal data are available in the privacy statement at http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf]
Contents
Part A. CONCEPT NOTE.. 5
1ÂÂÂ Instructions for drafting the concept note. 5
Summary of the action. 5
Description of the action (max 1 page) 6
Relevance of the action (max 3 pages) 6
2ÂÂÂ Checklist for the concept note. 8
3ÂÂÂ Declaration by the applicant for the concept note. 10
4ÂÂÂ Assessment grid for the concept note. 11
Part B. Full Application Form... 12
1ÂÂÂ General information. 12
2ÂÂÂ The action. 13
Description of the Action. 13
Budget, amount requested from the Contracting Authority and other expected sources of funding 16
Applicant’s experience of similar actions. 16
2.2. Co-applicant(s)'s experience of similar actions. 17
2.3. Affiliated entitiy(ies) experience of similar actions (if applicable) 18
3ÂÂÂ The applicant 20
Identity. 20
Profile. 21
Capacity to manage and implement actions. 29
List of the management board/committee of your organisation. 32
4ÂÂÂ The Co-applicant(s) 33
Identity. .
Profile. 34
5ÂÂÂ AFFILIATED ENTITY(ies) participating in the action. 35
Description of the affiliated entity(ies) 35
ÂAffiliated entity(ies)'s Statement .
Mandate. 37
Affiliated entity(ies)'s Statement 38
6ÂÂÂ Associates of the applicant participating in the action. 39
7ÂÂÂ Checklist for the full application form.. 40
8ÂÂÂ Declaration by the applicant 43
9ÂÂÂ Assessment grid FOR the full application form.. 44
Part B. Full Application Form
Date: 2015-12-17; view: 1187
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