STANDARD GRANT APPLICATION FORM FOR

‘GRANTS FOR AN ACTION’ *

(Multibeneficiary)

1
 NAME AND REFERENCE NUMBER OF THE CALL FOR PROPOSALS

SUMMARY OF THE APPLICATION

Title:

Identity of the [Option 1: Applicant No1] — [Option 2: Coordinator]:

Summary of the action:

Duration (in months):

Requested amount (in €):

Please make sure that your application:

 is submitted on the correct form, completed in full and dated;
 is signed by the person authorised to enter into legally binding commitments on behalf
of the applicant;
 presents a budget in conformity with the funding rules;
 meets the submission arrangements set out in the call;
 is submitted by the deadline.]
The evaluation committee or, where appropriate, the authorising officer responsible may ask
an applicant to provide additional information or to clarify the supporting documents
submitted in connection with the application, provided that such information or clarification
does not substantially change the proposal.
By submitting an application the applicant accepts that in case of award certain data like the
name, locality and amount (amongst others) will be published.
No information will be published for scholarships, aid to natural persons and other direct
support paid to natural persons in most need.

2
I. INFORMATION ON THE APPLICANTS

1 REFERENCES OF THE APPLICANTS

1.1 [Option 1: Applicant No1] — [Option 2: Coordinator]

1.1.1 IDENTITY OF THE APPLICANT

Official name in full:

Acronym:
(if applicable)

Official legal form:

(Not applicable if the applicant is a natural person)

Legal personality1:
(Reply by "YES" or "NO").
(In case you answered with "NO"):

For entities with no legal personality under national law please indicate the representative
empowered to take part in court proceedings on their behalf:

Place of establishment or registration:

(Address and country)

Entity registration number:

(Not applicable if the applicant is a public-sector body. For natural persons, the applicant should indicate the
number of his/her identity card or, failing that, of his passport or equivalent.)

VAT number (if applicable):

The legal details are attached in the Legal Entity Form in the annex

1.1.2 CONTACT DETAILS

Street address:

Postcode:

City:

1
Legal personality is understood as applicant’s capacity to sign contracts and constitute a party in court
proceedings under the applicable national legislation.

3
 Region (if applicable):

Country:

Telephone: Mobile:

Fax:

E-mail address:

Website:

Any change in the addresses, phone numbers, fax numbers or e-mail, must be notified in
writing to the Authorising Officer. The Authorising officer will not be held responsible in
the event that it cannot contact an applicant.

1.1.3 CONTACT PERSON RESPONSIBLE FOR THE PROPOSAL

Family name: First Name:

Position/Function:

Telephone: Mobile:

Fax:

E-mail address:

1.1.4 LEGAL REPRESENTATIVE (PERSON AUTHORISED TO SIGN THE

AGREEMENT)

Family name: First Name:

Position/Function/Mandate:

Telephone: Mobile:

Fax:

E-mail address:

1.2 Applicant No 2 (Repeat this part as often as is required to include all applicants).

4
 1.2.1 IDENTITY OF THE APPLICANT

Official name in full:

Acronym:
(if applicable)

Official legal form:

(Not applicable if the applicant is a natural person)

Legal personality2:
(Reply by "YES" or "NO")
(In case you answered with "NO"):

For entities with no legal personality under national law please indicate the representative
empowered to take part in court proceedings on their behalf:

Place of establishment or registration:

(Address and country)

Entity registration number:

(Not applicable if the applicant is a public-sector body. For natural persons, the applicant should indicate
the number of his/her identity card or, failing that, of his passport or equivalent)

VAT number (if applicable):

The legal details are attached in the Legal Entity Form in the annex.

1.2.2 CONTACT DETAILS

Street address:

Postcode:

City:

Region (if applicable):

Country:

2
Legal personality is understood as applicant’s capacity to sign contracts and constitute a party in court
proceedings under the applicable national legislation.

5
 Telephone: Mobile:

Fax:

E-mail address:

Website:

Any change in the addresses, phone numbers, fax numbers or e-mail, must be notified in
writing to the Authorising Officer. The Authorising Officer will not be held responsible in
the event that it cannot contact an applicant.

1.2.3 CONTACT PERSON RESPONSIBLE FOR THE PROPOSAL

Family name: First Name:

Position/Function:

Telephone: Mobile:

Fax:

E-mail address:

1.2.4 LEGAL REPRESENTATIVE (PERSON AUTHORISED TO SIGN THE

AGREEMENT)

Family name: First Name:

Position/Function/Mandate:

Telephone: Mobile:

Fax:

E-mail address:

1.3 Affiliated Entity No 1 (Repeat this part as often as is required to include all affiliated entities).

1.3.1 IDENTITY OF THE AFFILIATED ENTITY

(This box shall be filled in by all affiliated entities, including the case where several entities satisfy the criteria
for being awarded a grant and together form ONE entity, to be treated as the sole beneficiary.)

6
 Official name in full:

Acronym:
(if applicable)

Official legal form:

(Not applicable if the applicant is a natural person)

Legal personality3:
(Reply by "YES" or "NO"):
(In case you answered with "NO"):

For entities with no legal personality under national law please indicate the representative
empowered to take part in court proceedings on their behalf:

Place of establishment or registration:

(Address and country)

Entity registration number:

(Not applicable if the applicant is a public-sector body. For natural persons, the applicant should indicate
the number of his/her identity card or, failing that, of his passport or equivalent.)

VAT number (if applicable):

Legal or capital link with the applicant, if applicable:

The affiliated entity should provide a short description of the legal or capital link with the applicant and
provide the statutory documents and/or consolidated accounts.

2 BANK DETAILS

The bank details are attached in the Bank Account Form (BAF) in the annex.

3 PROFILE OF THE APPLICANTS

3.1 [Option 1: Applicant No1] — [Option 2: Coordinator]

PROFILE OF THE [APPLICANT No1] [Coordinator] — GENERAL AIMS AND

ACTIVITIES

3
Legal personality is understood as applicant’s capacity to sign contracts and constitute a party in court
proceedings under the applicable national legislation.

7
 [Year of foundation]:

The entity shall state his legal status by ticking one or several options
Public body International Organisation
Non-profit making organisation Social Partner
Educational and training establishment Research Centre/Institute
Other (please specify) SME
Natural Persons

The [applicant No1] [Coordinator] should provide a short description of the

organisation/group/consortium including affiliated entities. Where appropriate include
information on membership, with respect to the eligibility criteria indicated in the specific
call.

3.2 [Applicant No 2] (Repeat this part as often as is required to include all applicants)

PROFILE OF THE APPLICANT — GENERAL AIMS AND ACTIVITIES

[Year of foundation]:

The entity shall state his legal status by ticking one or several options
Public body International Organisation
Non-profit making organisation Social Partner
Educational and training establishment Research Centre/Institute
Others (please specify) SME
Natural Persons

3.3 Affiliated Entity No 1 (Repeat this part as often as is required to include all affiliated entities)

PROFILE OF THE AFFILIATED ENTITY No 1 — GENERAL AIMS AND

ACTIVITIES

[Year of foundation]:

The entity shall state his legal status by ticking one or several options

8
 Public body International Organisation
Non-profit making organisation Social Partner
Educational and training establishment Research Centre/Institute
Others (please specify) SME
Natural Persons

4 INFORMATION ON THE GOVERNANCE OF THE APPLICANTS

4.1 [Option 1: Applicant n.1] — [Option 2: Coordinator]

4.1.1 APPLICANT’S STRUCTURE

List the organisations and/or natural persons holding capital or shares in the applicant,
where appropriate specifying the proportion held (insert rows if necessary)

Organisation/Natural person Proportion held

4.1.2 APPLICANT’S MANAGEMENT

List the members of the applicant’s administrative board or equivalent body, specifying
their profession and position (insert rows if necessary)

Member Profession/Position

4.2 [Applicant n. 2] (Repeat this part as often as is required to include all applicants)

4.2.1 APPLICANT’S STRUCTURE

List the organisations and/or natural persons holding capital or shares in the applicant,
specifying the proportion held where appropriate (insert rows if necessary).

Organisation/Natural person Proportion held

9
4.2.2 APPLICANT’S MANAGEMENT
List the members of the applicant’s administrative board or equivalent body, specifying
their profession and position (insert rows if necessary).

Member Profession/Position

10
II. OPERATIONAL AND FINANCIAL CAPACITY

1 OPERATIONAL CAPACITY

1.1 [Option 1: Applicant No1] — [Option 2: Coordinator]

OPERATIONAL CAPACITY TO COMPLETE THE PROPOSED ACTION OF

THE APPLICANT

The applicant should provide a description of its relevant competences and previous
experiences as well as those of the key staff who will be involved in the project (according
to their profiles or CVs) as a proof of its capacity to implement the action effectively.

Name of the applicant:

Project title: Sector

Location of the Amount of Role in the Budgetary Dates (from

action the action action: share in the dd/mm/yyyy to
(EUR) Coordinator, project dd/mm/yyyy)
co-applicant,
affiliated
entity

… … … … …

Objectives and results of the

action

1.2 Applicant No2 (Repeat this part as often as is required to include all applicants)

OPERATIONAL CAPACITY TO COMPLETE THE PROPOSED ACTION OF

THE APPLICANT

The applicant should provide a description of its relevant competences and previous
experiences as well as those of the key staff who will be involved in the project (according
to their profiles or CVs) as a proof of its capacity to implement the action effectively.

Name of the applicant:

Project title: Sector

11
 Location of the Amount of Role in the Budgetary Dates (from
action the action action: share in the dd/mm/yyyy
(EUR) Coordinator, project to
co-applicant, dd/mm/yyyy
affiliated )
entity

… … … … …

Objectives and results of the

action

1.3 Affiliated Entity No1 (Repeat this part as often as is required to include all affiliated entities)

OPERATIONAL CAPACITY TO COMPLETE THE PROPOSED ACTION OF

THE AFFILIATED ENTITY No 1

The affiliated entity should provide a description of its relevant competences and previous
experiences as well as those of the key staff who will be involved in the project (according
to their profiles or CVs) as a proof of its capacity to implement the action effectively.

Name of the entity:

Project title: Sector

Location of the Amount of Role in the Budgetary Dates (from

action the action action: share in the dd/mm/yyyy to
(EUR) Coordinator, project dd/mm/yyyy)
co-applicant,
affiliated
entity

… … … … …

Objectives and results of the

action

2 FINANCIAL CAPACITY

12
 LEGAL NOTICE
This section should not be filled in by applicants who are natural persons in receipt of
scholarships or natural persons most in need and in receipt of direct support.
For grants of or below EUR 60 000 as well as for grants to public bodies and international
organisations the only supporting document to be required is the Declaration of Honour
provided in section 5.
Where the application concerns grants for an action for which the amount exceeds EUR 750
000, or operating grants which exceed EUR 100 000, an audit report produced by an
approved external auditor must be submitted, [except for education and training
establishments and, in case of agreements with a number of beneficiaries, beneficiaries who
have accepted joint and several liabilities or who do not bear any financial responsibility] .
This report shall certify the accounts for the last financial year available.

2.1 [Option 1: Applicant No1] — [Option 2: Coordinator]

FINANCIAL CAPACITY OF THE [CO-ORDINATOR][APPLICANT

The applicant must show that it has sufficient and stable sources of funding to carry out the
action throughout the entire period for which the action is planned and to participate in its
funding. The indicators refer to the last two financial years for which accounts have been
closed.

Year N [Year N-1]

Turnover or equivalent

Gross operating profit

Total liabilities

Equity or equivalent

Current asset

Short-term debt (< 1 year)

Total payroll

2.2 [Applicant No 2 ] (Repeat this part as often as is required to include all applicants)

FINANCIAL CAPACITY OF THE APPLICANT

The applicant must show that it has sufficient and stable sources of funding to carry out the
project throughout the entire period for which the action is planned and to participate in its
funding. The indicators refer to the last two financial years for which accounts have been
closed.

Year N [Year N-1]

13
Turnover or equivalent

Gross operating profit

Total liabilities

Equity or equivalent

Current asset

Short-term debt (< 1 year)

Total payroll

[2.3 Affiliated Entity No 1] (Repeat this part as often as is required to include all affiliated entities)

FINANCIAL CAPACITY OF THE ENTITY (No 1 - to be repeated for each affiliated

entity. This box shall ONLY be filled in the case where several entities satisfy the criteria for being awarded
a grant and together form ONE entity, to be treated as the sole beneficiary

The entity must show that it has sufficient and stable sources of funding to carry out the
project throughout the entire period for which the action is planned. The indicators refer to
the last two financial years for which accounts have been closed.

Year N [Year N-1]

Turnover or equivalent

Gross operating profit

Total liabilities

Equity or equivalent

Current asset

Short-term debt (< 1 year)

Total payroll

[2.4 GUARANTEES GRANTED BY THIRD PARTIES ]

(applicants should state whether there are any guarantees provided by one or more third party, for example a
State guarantee)

14
III. INFORMATION ON THE ACTION FOR WHICH THE GRANT IS REQUESTED

1 DESCRIPTION OF THE ACTION

Title:

Reference:

a) Describe the general and specific objectives that the action aims to achieve:
Applicants should explain how the general and specific objectives of the action will contribute to the
objectives of the Union grant programme concerned. Where possible, specify related indicators to assess
the project’s achievements and expected impacts.

b) Describe the action on the basis of the main activities planned and where it will be
implemented

c) Methodology to be followed/project implementation

Applicants 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. Applicants should also explain how
they intend to distribute the tasks among themselves. This might include support to third parties.

In case of financial support foreseen to third parties the applicant should specify the different types of activity,
the definition of the persons or categories of persons which may receive such financial support and the criteria
to give it and the maximum amount. If the financial support takes the form of a prize the applicant should
specify the conditions for participation in the contest, the award criteria, the amount of the prize and the
payment arrangements.

The applicant should explain which part of the action will be subcontracted (list of main activities to be
carried out) as well as which activities will be undertaken by affiliated entities (if applicable).

d) Expected results and their use:

Applicants should specify the benchmarks or deliverables which they intend to employ to achieve
the expected results and targets and how they will be used and disseminated.

e) Arrangements for monitoring/supervision of the operation and any risks involved

in its implementation:
Applicants should explain how the action will be supervised. They should refer to risks involved in its
implementation, how they might affect the objectives and outcomes of the action and how they could be
mitigated.

f) Sustainability of the project’s achievements:

Applicants should explain how sustainability will be secured once the action has been completed. This can

15
 include considerations about different dimensions of sustainability: financial, economic, institutional
(structures which would allow the results of the action to continue), environmental, policy, etc. (where
applicable, depending on the provisions of the basic act).

2 PLANNED DURATION OF THE ACTION (in months):

Planned starting date:

TIMETABLE FOR EACH STAGE OF THE ACTION SHOWING MAIN DATES

AND EXPECTED RESULTS FOR EACH STAGE
Please provide in Annex the timetable provided with the call

LEGAL NOTICE
Applicants are informed that, under the Financial Regulation applicable to the general budget of
the European Union, no grants may be awarded retrospectively for actions already completed.
In those exceptional cases accepted by the Commissionwhere applicants demonstrate the need to
start the action or work programme before the agreement is signed or the decision notified,
expenditure eligible for financing may not have been incurred before the grant application was
lodged or in the case of an operating grant, before the start of the beneficiary's budgetary year.

3 3 BUDGET

Estimated Budget — Annex 1

Applications must include (1) the general budget overview (see template published with the call) and (2) the
detailed budget overview (see template published with the call).

16
IV. ADDITIONAL FUNDING

1 UNION FUNDING

1.1 APPLICATIONS AND/OR ONGOING FUNDING OF THE UNION

Have any of the applicants or affiliated entities received or applied for any Union funding
for the same action or part of the action or for its functioning during the same financial
year?
NO
YES — Continue to the following table

APPLICATION, GRANT OR ANY OTHER EU FUNDING — To be specified for each

of the applications or obtained grants in the current or previous years (add columns if
necessary)

Programme 1 Programme 2

Title of the action (or part

of the action)

Union Programme
concerned

Union Institution or
Body/Agency to which the
application was submitted
or which took the award
decision

Year of award or
application and duration
of the operation

Value of the application,

grant or other Union
funding

LEGAL NOTICE
Applicants must inform the Commissiondepartment 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.

17
 2 OTHER SOURCES OF EXTERNAL FUNDING — NON UNION

2.1 SUPPORT AWARDED

Have any of the applicants or any of the affiliated entities already received confirmation
relating to any external funding for the action?
NO
YES — Continue to the table in the Annexes (Budget)

CONTRIBUTIONS BY THIRD PARTIES

The applicants should indicate the details of the third party following the model below — Third parties must
be the same as those listed in the budget (add rows if necessary)

Third Party 1

Official name in full

Official address

Estimated amount of funding to be provided

for the operation

Conditions or reservations (if any)

2.2 REQUESTED SUPPORT

Have any of the applicants or any of the affiliated entities requested, applied or are awaiting
confirmation relating to external funding for the action?
NO
YES — Continue to the table in the Annexes (Budget)

DETAILS OF FUNDS REQUESTED — The applicant should indicate the details of the
requested funds following the model below (add rows if necessary)

Organisation/Entity Concerned 1

Name of the organisation

Official address

Requested amount

If processing your reply to the call for proposalsinvolves the recording and processing of
personal data (such as your name, address and CV), such data will be processed pursuant to
Regulation (EU) 2018/1725 of 23 October 2018 on the protection of natural persons with
regard to the processing of personal data by the Union institutions, bodies, offices and

18
agencies and on the free movement of such data. Unless indicated otherwise, any personal
data requested are required to evaluate your application in accordance with the [call for
proposals][invitation to submit a proposal] and will be processed solely for that purpose by
the Director of Directorate C of the Directorate General for Mobility and Transport. Details
concerning the processing of your personal data are available on the privacy statement at:
http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf.
Your personal data may be registered in the Early Detection and Exclusion System (EDES) if
you are in one of the situations mentioned in Article 136 of the Financial Regulation4. For
more information, see the Privacy Statement on
http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm

Annexes: - Budget
Bank Account Form (BAF)]
Legal Entity Form (LEF)]

Version September 2016

V. DECLARATION ON HONOUR

Ref: CALL FOR PROPOSAL "Technical Assistance for the development

and collection of Road safety Key Performance Indicators (KPI)"

Reference number: MOVE/C2/2022-54

The undersigned [insert the name of the person signing this form], representing:
(only for natural persons) himself (only for legal persons) the following entity:
4
Regulation (EU, Euratom) 2018/1046 of the European Parliament and of the Council of 18 July 2018 on
the financial rules applicable to the general budget of the Union (OJ L 193, 30.7.2018, p.1).

19
 or herself:
ID or passport number: Full official name:
Official legal form:
Statutory registration number:
Full official address:

VAT registration number:

[which has been authorised to sign the present declaration on behalf of the following other
entities5:
[insert names of other entities on behalf of which the declaration is being signed]]

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 6;
 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(ies) 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 and the name(s) of the concerned entity(ies) 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;

5
Please also consult the call for proposals in case specific options are defined to sign the declaration
6
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.

20
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

21
 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(ies) 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)

22
IV – REMEDIAL MEASURES

If for any 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/Agency may request any 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/Agency may request any 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(ies) subject to this declaration accept(s) the terms
and conditions laid down in the grant agreement/grant decision.
The entity(ies) 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 name Date Signature

23
 CHECKLIST FOR APPLICANTS

This checklist shall be adapted according to the options chosen within the form and
completed according to the special requirements defined for the programme or call
for proposals

All sections of the application form have been filled in, where appropriate,
in accordance with the guide for applicants or any other document
provided as guidance related to the programme concerned.

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

Legal details have been included in the Legal Entity Form annexed.

Bank details have been included in the Bank Account Form.

For concerned entities (please consult the Legal Notice under section 2),
balance sheets or extracts from balance sheets for the last two years for
which accounts have been closed have been included with the application
form.

The declaration(s) of honour has (have) been signed and attached.

24