EUROPEAN COMMISSIONDIRECTORATE-GENERALENVIRONMENTDirectorate F - StrategyUnit F.2 - Strategy, Coordination & Communication

GRANT APPLICATION FORM FOR "GRANTS FOR AN ACTION"

PROGRAMME CONCERNEDPilot project "Transversal communication on EU policies related to environment: Tackling

environmental awareness deficit of EU citizens through audiovisual tools (movies)" Decision of the Commission C(2013) 4170 of 5 July 2013.

REFERENCE NUMBER OF THE CALL FOR PROPOSALSENV.F2/2013/01

SUMMARY OF THE APPLICATIONTitle (Must be provided in EN):

Identity of the applicant:

Summary of the action (Must be provided in EN, max 2000 words):

Duration (in months):

Requested amount (in €):

The applicants are reminded that:- Applications must be sent no later than the deadline for submitting applications referred

to in Section 3 of the Guidelines for the Call for Proposals. The postmark, the date of collection by the courier or the acknowledgement of receipt dated and signed by the responsible official will serve as proof of the date of submission of the proposal.

- Applications sent by other means (e.g. by fax or by e-mail) or delivered to other addresses will be rejected;

- Applications must be submitted in writing, using the relevant application forms available at: http ://ec.europa.eu/environment/funding/grants_en.htm and must not be handwritten;

- Incomplete and not signed applications might be rejected;- Applications must be drafted in one of the EU official languages. However, in order to

speed up the evaluation process, applicants who wish to apply in another language are encouraged to provide a summary of their proposal in English.

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- Only one application will be accepted per movie. In case more than one application are received for the same project, only the application from the legal entity with the highest share of co-production budget will be considered admissible.

Failure to comply with those requirements will lead to the rejection of the application.

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I. INFORMATION ON THE APPLICANT/COORDINATOR

I.1 IDENTIFICATION OF THE APPLICANT/COORDINATOR

The information stated below will be used to establish the legal agreement between the European Commission and the applicant if selected.

In case of a consortium – this section has to be filled in by the main applicant/coordinator of the consortium. Declarations of the partners/affiliated entity/ies designing the applicant as coordinator of the proposal must be provided.

Full legal name of the Company:Short name (where applicable) .......................................................................................................Acronym (where applicable) .......................................................................................................Legal Status (association, commercial company) .............................................................................Foundation date: .......................................................................................................Activity: .......................................................................................................VAT No. .......................................................................................................Legal Registration No: .......................................................................................................Statutory Legal Representative (enclose CV):...................................................................................Position in the company: .......................................................................................................

Address of the registered office:Street: ...................................................................... Tel: ..........................................................Town: ...................................................................... Fax: ..........................................................Post Code: ................... Country ............................ E-mail: .....................................................

Address for correspondence (if different):Street: ...................................................................... Tel: ..........................................................Town: ...................................................................... Fax: ..........................................................Post Code: ................... Country ............................ E-mail: .....................................................

Contact person for this project:Contact Person: ..................................................................................................Position in the company: ..................................................................................................Phone: .........................................................................................................................................e-mail:

Legal representative authorised to sign the agreementFamily name: ............................................................. First Name: ..............................................Position/Function: ......................................................Mandate:

Name of the legal representative:

Signature of the legal representative: Date:

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I.2 IDENTIFICATION OF THE PARTNER(S), IF NEEDED

In case of a consortium – this section has to be filled by each of the partners and affiliated entity/ies, if any (repeat this section as many times as necessary).

Full legal name of the Company:Short name (where applicable) .......................................................................................................Acronym (where applicable) .......................................................................................................Legal Status (association, commercial company) .............................................................................Foundation date: .......................................................................................................Activity: .......................................................................................................VAT No. .......................................................................................................Legal Registration No: .......................................................................................................Statutory Legal Representative (enclose CV):...................................................................................Position in the company: .......................................................................................................

Address of the registered office:Street: ...................................................................... Tel: ..........................................................Town: ...................................................................... Fax: ..........................................................Post Code: ................... Country ............................ E-mail: .....................................................

Address for correspondence (if different):Street: ...................................................................... Tel: ..........................................................Town: ...................................................................... Fax: ..........................................................Post Code: ................... Country ............................ E-mail: .....................................................

Contact person for this project:Contact Person: ..................................................................................................Position in the company: ..................................................................................................Phone: .........................................................................................................................................e-mail:

Legal representative Family name: ............................................................. First Name: ..............................................Position/Function: ......................................................

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I.3 LEGAL ENTITY IDENTIFICATION FORM

PLEASE USE THE RELEVANT FORM AVAILABLE ON THE WEBSITE:http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm

In case of a consortium – the information must be provided by the main applicant/coordinator, by all partners and affiliated entities.

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I.4. FINANCIAL IDENTIFICATION – BANK ACCOUNT FORM

PLEASE USE THE RELEVANT FORM AVAILABLE ON THE WEBSITE:http://ec.europa.eu/budget/contracts_grants/info_contracts/financial_id/financial_id_en.cfm

In case of a consortium – the information must be provided only by the main applicant/coordinator.

THE APPLICANTS ARE REMINDED THAT: The account to be used for the action for which a grant is being requested must allow payments made by the Union to be identified

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I.5. INFORMATION ON THE GOVERNANCE OF THE APPLICANT (AND THE PARTNERS)

In case of a consortium – the information must be provided by the main applicant/coordinator and by all partners (repeat table as many times as needed).

Shareholders of first rank:Name of shareholder Nationality/Legal residence % shareholding.......................................... .......................................... ................................................................................................. .......................................... ................................................................................................. .......................................... ................................................................................................. .......................................... .......................................................

Shareholders of second rank:State precisely on an explanatory sheet the information requested to prove that the company is held either directly, or by majority share by citizens of Member states of the European Union and established in those countries. In the case of insufficient information, the producer may be considered as ineligible.

Existing subsidiaries of the company: Name of Company Country Main activity % shareholding.......................................... ................ ............................................... ..................................................................... ................ ............................................... ..................................................................... ................ ............................................... ...........................

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I.6. INFORMATION CONCERNING ELIGIBILITY OF THE APPLICANT (and ITS PARTNERS)

In order to assess the applicants' eligibility, the following supporting documents are requested:

Eligibility criterion (b):

Applicants and their partners must be legally registered in one of the Member States of the European Union"

- private entity: extract from the official journal, copy of articles of association, extract of trade or association register, certificate of liability to VAT (if, as in certain countries, the trade register number and VAT number are identical, only one of these documents is required);

- public entity: copy of the resolution or decision establishing the public company, or other official document establishing the public-law entity.

Eligibility criterion (c):

"Applicants and their partners shall be owned and continue to be owned, whether directly or by majority shareholding, by nationals or public entities from the Member States of the European Union."

Trade or association register or other certificate mentioning the owners of the company, their respective quota of ownership and the nationality of the owners.

If these certificates do not mention the ownership of the entity and the nationality of the owners, a statement (see section V.1 of this application form for the coordinator and section V.2 for the partners) duly completed, dated and signed by an authorised company representative

Eligibility criterion (d):

"Applicants or their partners must have the proven record that they have produced at least one sustainable development/nature/biodiversity movie (minimum duration of 60 minutes) of high cinematographic quality, that was/were commercially released to the public in the cinema within the last 5 years in at least 7 Member States with a minimum audience of 1.5 million admissions and that has positively contributed to the awareness raising of the problem among general public."

List of release countries (with date of release), brief content summary, media reviews, viewership and / or admission figures (see section I.6.1 of this application form)

In case of a consortium the above supporting document shall be submitted also by the partners and the affiliated entities (if any).

Moreover, the main applicant/coordinator shall also pay attention to the statement V.1, which includes information on the following eligibility criteria:

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Eligibility criterion (a)

"Public or private entities whose main activity is audio-visual production and their partners;

Eligibility criterion (e)

"Applicants must be directly responsible for the preparation and production of the movie. Applications presented by a body acting as intermediary for a third party are not acceptable."

I.6.1 INFORMATION CONCERNING ELIGIBILITY CRITERION (d)

Repeat these tables as many times as needed

Responsible organisation: ..........................................................................................................

Coordinator/partner involved: .................................................................................................(in case they are not the responsible organisation)

Role of the coordinator/partner: ..............................................................................................(in case they are not the responsible organisation)

Title (EN): ...................................................................................................................................

Original Title: .............................................................................................................................

Duration:………………………

Role of the coordinator/partner: ..............................................................................................

Brief content summary (must be in EN): (max 1000 words)

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

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

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

Number of EU countries in which the film was commercially released in cinemas:……..………………

Total viewership (or admission figure) for all countries where the film was commercially released:……………

Details by country:Country 1 Date of release: Viewership (or admission figure):.......................................... .......................................... ................................................................................................. .......................................... ................................................................................................. .......................................... ................................................................................................. .......................................... .......................................................

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II. OPERATIONAL AND FINANCIAL CAPACITY OF THE APPLICANT

The applicant should provide the following documents as evidence of operational and logistical capacity to complete the proposed action.

In case of a consortium – the information must be provided by the coordinator, by its partners and affiliated entities (if any), for their respective role.

(a) Professional competencies of the staff

List of team that will be directly responsible for managing of and / or directly attached to the implementation of the submitted action. Curricula vitae (and when applicable work samples or artistic portfolios) must be provided.

NOTE: CVs must be enclosed either in alphabetical order or in order following reference numbers (in which case an overview of names and corresponding reference numbers must be provided)

Standard CV Format, available at the following address: http://www.europass.cedefop.europa.eu/europass/home/hornav/Downloads/EuropassCV/CVTemplate/navigate.action

(b) Previous relevant experience

List of productions already produced (either as sole production company; or as major co-producer in the financing plan or the delegate producer; or that their Chief Executive or one of their shareholders has a personal credit on the work as producer or delegate producer) in the area related to actions that are subject of this call for proposals

The list should indicate at minimum:

- Title of the production

- Year of production

- Category

- Duration

- Territories sold

(c) Logistical and managerial capacity to undertake the proposal within stated technical parameters

c.1. An overview of human resources available to undertake the action.

c.2. A description of the technical equipment, tools or facilities and patents at the disposal of the applicant;

c.3. Documents relating to the ownership of rights - no later than on the date of submission, the coordinator must show that it holds the majority of the rights relating to the project for which support is being

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sought. It is required to provide a contract covering the rights to the artistic material included in the application. This must include at least: concept, subject, treatment or script. This contract must be duly signed and dated by author(s).

II. 2 FINANCIAL CAPACITY OF THE APPLICANT

In case of a consortium – the requested information and documents must be provided by all partners.

II.2.1. PROOF OF FINANCIAL CAPACITY

The applicant should provide the following documents as evidence of financial capacity:

a) The profit and loss account and the balance sheet for the last financial year for which the accounts were closed;

b) The table provided in the Annex C, filled in with the relevant statutory accounting figures, in order to calculate the ratios as detailed in the form.

c) For the applicant/coordinator, an audit report produced by an approved external auditor certifying the accounts for the last financial year available.

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III. INFORMATION ON THE PROJECT FOR WHICH THE GRANT IS REQUESTED

III.1 DESCRIPTION OF THE PROJECT

Title (EN): ...................................................................................................................................

Original Title: .............................................................................................................................

Brief project description (must be in EN. Max 1000 words):

In addition, script and 'treatment' must be enclosed in the application)

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

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

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

Cast and crew list:

Director: Name:....................................................... Nationality / Residence: ...................................

This film is the director’s:

1st film 2nd film Other

Script Writer: Name:....................................................... Nationality / Residence: ...................................

Main cast:Name: ...................................................... Nationality / Residence: ...................................

Name: ...................................................... Nationality / Residence: ...................................

Name: ...................................................... Nationality / Residence: ...................................

Composer:

Name:....................................................... Nationality / Residence: ...................................

Production design (art direction):

Name:....................................................... Nationality / Residence: ...................................

Director of photography:

Name:....................................................... Nationality / Residence: ...................................

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Editor:

Name:....................................................... Nationality / Residence: ........................................

Sound:

Name:....................................................... Nationality / Residence: ........................................

Shooting location(s):............................... Country: ................................................................

.................................................................. Country: .................................................................

.................................................................. Country: .................................................................

Laboratory:...............................................................................................................Country…………………………………………

III.2 INFORMATION CONCERNING CO-PRODUCTION

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The applicants should note that in case there are co-producers involved in the project, a declaration designating the applicant as the delegate producer in the case of grant award must be enclosed in the application.Co-production agreement(s)Please indicate the country of origin of the co-production companies1: Are you the majority producer?

YES NOAre there any co-producer(s) bringing eligible costs to the budget or costs that will not be invoiced to the applicant company (this company will enter in the eventual agreement as co-beneficiary)?

YESNO

If YES, please specify the name of the company, the legal representative, the legal address, the Vat N° - the Legal registration N°, the type of eligible cost your co-producer(s) will bring, the reference of financing institutions / agreement and the related amount.

Name of company / Legal representative

Legal address VAT N° / Legal registration N°:

Type of eligible costs

Reference of financing

Institution / Agreement

Amount(EUR)

Co-producer 1

Co-producer 2

Co-producer 3

Co-producer 4

1 Country Abbreviation: Austria - AT, Belgium - BE, Bosnia and Herzegovina - BA, Bulgaria - BG, Croatia - HR, Cyprus - CY, Czech Republic - CZ, Denmark - DA, Estonia - EE, Finland - FI, France - FR, Germany - DE, Greece - EL, Hungary - HU, Ireland - IE, Iceland - IS, Ireland - IE, Italy - IT, Liechtenstein - LI, Latvia - LV, Lithuania – LT, Luxembourg - LU, Malta - MT, Norway - NO, the Netherlands - NL, Poland - PL, Portugal - PT, Romania - RO, Slovakia - SK, Slovenia – SI, Spain -ES, Sweden - SU, Switzerland – CH, the United Kingdom - UK. More information at http://publications.europa.eu/code/en/en-370100.htm

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III.3 INFORMATION CONCERNING EU DISTRIBUTION APPROACH

Number of EU countries in which the project is expected to be commercially released in cinemas:………………………………………………

Justification for the above estimation:..............................................................................................................................................................................................................................................................................................................

Estimated number of viewers that the project is expected to reach in the EU via commercial release in cinemas:………………………………………………

Justification for the above estimation:..............................................................................................................................................................................................................................................................................................................

Estimated number of viewers that the project is expected to reach in the EU in total (through combination of all the distribution channels foreseen)………………………………………………

Justification for the above estimation:..............................................................................................................................................................................................................................................................................................................

If already available, please describe:

EU distribution company(-ies)/sales agent(s) involved and character of deals (territories, Minimum guarantees, terms etc.)....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Intended focus-point territories, specific reformatting/dubbing/subtitling for intended territories............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Intended Promotional Activities.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Intended trade fair/festival attendance:.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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III.4 OTHER INFORMATION RELATED TO AWARD CRITERIA

a) The proposed movie subject should relate closely to the thematic priority objective of the Commission’s proposal for a new Environment Action Programme for 2020 (“Living well, within the limits of our planet", http://ec.europa.eu/environment/newprg/index.htm) aiming to:

'Protect, conserve and enhance the Union’s natural capital'

The proposed new action programme shows that in order to achieve a sustainable way of life within the planets limits, the engagement of all actors, sectors (public and private) and citizens will be essential. How will the proposed movie contribute to a wider awareness in society at large?

If yes, in describe in what way (max 500 words)

…………………………………………………………………………………………………

………………………………………………………………………………………………….………………………………………………………………………………………………….

To ensure long term sustainability early awareness and education is of outmost importance. Will the proposed movie contribute to the awareness of children by including some educational components?

NO

YES

If yes, in describe in what way (max 300 words)

…………………………………………………………………………………………………

………………………………………………………………………………………………….

………………………………………………………………………………………………….

b) The proposed movie will support the Resource Efficiency Roadmap (http://ec.europa.eu/environment/resource_efficiency/about/roadmap/index_en.htm)

NO

YES

If yes, in describe in what way (max 500 words)

…………………………………………………………………………………………………

………………………………………………………………………………………………….………………………………………………………………………………………………….

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c) The Flash 2010 Eurobarometer on the attitudes of Europeans towards the issue of biodiversity revealed very severe knowledge gaps (e.g. 81% of the respondents did not know what biodiversity loss meant, 62% did not feel well informed about biodiversity, 78% of the respondents had never heard about the Natura 2000 network). On the other hand there were a large proportion of respondents that considered that while they were already taking measures for biodiversity they would like to do even more.

How will the proposed movie contribute to fill in these severe awareness gaps and mobilise citizens to increase their contribution to biodiversity protection?

If yes, describe in what way (max 500 words)

…………………………………………………………………………………………………

………………………………………………………………………………………………….………………………………………………………………………………………………….

In particular, how will the proposed movie contribute to raise awareness about the EU nature legislation and Natura 2000If yes, describe in what way (max 500 words)

…………………………………………………………………………………………………

………………………………………………………………………………………………….…………………………………………………………………………………………………. d) The EU 2020 Biodiversity Strategy includes six targets that

pertain to 1) conservation of protected habitats and species 2) restoration of degraded ecosystems, 3) sustainable agriculture and forestry 4) sustainable fisheries 5) combatting invasive alien species 6) protecting global biodiversity. How many of these areas will be covered by the proposed movie? (http://ec.europa.eu/environment/nature/biodiversity/comm2006/2020.htm)

For those that will be covered, describe how they will be addressed (max 500 words)

…………………………………………………………………………………………………

………………………………………………………………………………………………….………………………………………………………………………………………………….

e) Describe methodology to be followed:

The applicant 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. This might include support to third parties.

Max 1000 words

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…………………………………………………………………………………………………

………………………………………………………………………………………………….

………………………………………………………………………………………………….

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f) Describe project management arrangements: The applicant should provide a detailed description of the organization of the project and of the implementation phase, specifying arrangements for monitoring, supervision and risk management. The applicant should also explain which part of the action might be subcontracted (list of main activities, or works to be carried out).

Max 1000 words

…………………………………………………………………………………………………

………………………………………………………………………………………………….

………………………………………………………………………………………………….

g) Describe arrangements for monitoring/supervision of the operation and risks involved in its implementation:

The applicant should explain how the project will be supervised. The applicant should refer to any risks involved in its implementation, how they might affect the objectives and outcomes of the project and how they could be mitigated.Max 1000 words

…………………………………………………………………………………………………

………………………………………………………………………………………………….

………………………………………………………………………………………………….

The applicants are reminded that the evaluation of the application with the view of the award criteria will be made based on the following evidence:

Award criteria Base for assessment

a) Technical coherence and quality of the proposal: proposal should be clear, detailed, coherent, realistic and feasible in terms of actions, timetable

All sections of the application form (and in particular information provided in the section III 'Informationo on the project for which the

grant is requested')b) Quality of the artistic approach

suggested for the project (visual and narrative)

At minimum script and treatment should be provided.

In additon, the applicant may submit other material that it judges necessary to present the artistic approach of the project. Such material is admissible only if provided in a technical format(s) that is(are) possble to be viewed / read using standard IT equipment / software available to the Commission.

c) Degree to which the project would promote a better understanding of the value of sustainable development,

Information provided in the point III.4 of this application, script and 'treatment'.

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biodiversity and nature to our society

d) Quality of the distribution approach (stategy and potential to reach EU audiencees and maximise awareness)

Informaiton provided in the point III.3 of this application

III.5 INFORMATION CONCERNING PROJECT DURATION

LEGAL NOTICEApplicants 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 Commission where 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.

Planned duration of the project (in months): ..........................................................................

Starting date: .................................................................................................................

Project timetable: .................................................................................................................

Semester 1 Semester 2 Activity Month 1 2 3 4 5 6 7 8 9 10 11 12 Preparation Activity 1 (title)

Implementation Activity 1 (title)

Preparation Activity 2 (title)

Etc.

NOTE: The above table is provided for guidance purposes only. The applicant may present the timetable in the form that is most relevant for the project for which the grant is requested. The submitted timetable must however contain detailed production and delivery schedule enabling the Commission to identify key steps in the progress of the action . Said production and delivery schedule will then be incorporated within any completion and payment schedule.

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3 III.6 INFORMATION CONCERNING PROJECT BUDGET

III.6.1 BUDGET SUMMARY (in €)

a) Eligible costs:b) Total costs:

c) Requested Union Funding:

d) Rate of funding requested:

III.3.2 DETAILED BUDGET

PLEASE USE THE FORM AVAILABLE IN ANNEX C TO THE GUIDELINES OF THE CALL FOR PROPOSALS

(posted separately as xls workbook)

The applicants are reminded that the applications must include a detailed estimated budget in balance in which all costs are given in euros.

Applicants from countries outside the euro zone may use either the conversion rates published in the Official Journal of the European Union, series C, during the month in which they are submitting the application, or the monthly rate published on the Commission's website at www.ec.europa.eu/budget/inforeuro/.

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IV. ADDITIONAL FUNDING

IV.1 UNION FUNDING

IV.1.1 IN PREVIOUS YEARS

Has the applicant already obtained any Union grants, contracts or loans from a Union Institution or body/agency of the Union, directly or indirectly for similar/complementary action(s) during the last 2 years?

NO

YES – Continue to the following table

GRANT, CONTRACT OR LOAN DETAILS – To be specified for each of them (previous years - add columns if necessary)

Programme 1 Programme 2Title of the operation

Union Programme concerned

Union Institution or Body/Agency which took the award decisionYear of award and duration of the operation

Value of the grant, contract or loan

IV.1.2 CURRENT YEARHas the applicant submitted grant/loan applications for similar/complementary action(s) or offers of service or an operating grant to the Union Institutions/bodies/agencies in the current year?

GRANT, CONTRACT OR LOAN DETAILS – To be specified for each of them (current year - add columns if necessary)

Programme 1 Programme 2Title of the operation

Union Programme concerned

Union Institution or Body/Agency which will

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take the award decisionPlanned duration of the operation

Estimated value of the grant, contract or loan

LEGAL NOTICEThe applicant must inform the [Commission] / [agency] department 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.

IV.2 OTHER SOURCES OF EXTERNAL FUNDING – NON UNIONIV.2.1 SUPPORT AWARDED

Has the applicant already received confirmation relating to any external funding for the action?

NO

YES – Continue to the following table.

The applicant must submit a letter confirming the financial contribution awarded or any other proof thereof, signed by each third party.

CONTRIBUTIONS BY THIRD PARTIES The applicant 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 1Official name in full

Official legal form

Official address

E-mail address

Person responsible who has signed the commitment letter (name/first name, title or position)

Estimated amount of funding to be provided for the operation

Pre-allocation of funding (if any)

Conditions or reservations (if any)

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IV.2.2 REQUESTED SUPPORT

Has the applicant requested, applied or are awaiting confirmation relating to any external funding for the action/working programme?

NO

YES – Continue to the table in the Annexes (Budget)

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V. DECLARATIONS BY THE APPLICANTS

V.1 DECLARATION BY THE APPLICANT/COORDINATOR

I, the undersigned, ….., authorised to represent the applicant/coordinator, hereby request from the Commission a grant of EUR …. with a view to implementing the action on the terms laid down in this application.

I certify on my honour that the organisation I represent is not in one of the following situations which would exclude it from receiving Union grants:

a) is bankrupt or being wound up, is having its affairs administered by the courts, has entered into an arrangement with creditors, has suspended business activities, is the subject of proceedings concerning those matters, or is in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

b) has been convicted of an offence concerning professional conduct by a judgment of a competent authority of a Member State which has the force of res judicata;

c) has been guilty of grave professional misconduct proven by any means which the Commission can justify including by decisions of the European Investment Bank and international organisations;

d) is not in compliance with all its obligations relating to the payment of social security contributions and the payment of taxes in accordance with the legal provisions of the country in which it is established, with those of the country of the authorising officer responsible and those of the country where the action is to be implemented;

e) has been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation, money laundering or any other illegal activity, where such activity is detrimental to the Union's financial interests;

f) is subject to an administrative penalty for being guilty of misrepresenting the information required as a condition of participation in a procurement procedure or another grant award procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts or agreements covered by the Union's budget.

I also declare that the organisation I represent:

g) has no conflict of interests in connection with the grant; a conflict of interests could arise in particular as a result of economic interests, political or national affinity, family, emotional life or any other shared interest;

h) will inform the Commission, without delay, of any situation considered a conflict of interests or which could give rise to a conflict of interests;

i) has not granted and will not grant, has not sought and will not seek, has not attempted and will not attempt to obtain, and has not accepted and will not accept any advantage, financial or in kind, to or from any party whatsoever, where such advantage constitutes an illegal practice or involves corruption, either directly or indirectly, inasmuch as it is an incentive or reward relating to the award of the grant;

j) provided accurate, sincere and complete information within the context of this grant award procedure.

I declare that the organisation I represent is fully eligible in accordance with the criteria set

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out in the specific call for proposals and in particular, that:

that the main activity of the organisation I represent is audio-visual production; that the the organisation I represent is owned and continues to be owned, whether

directly or by majority shareholding, by nationals from the member States of the European Union.

The the applicant is directly responsible for the preparation and production of the movie.

I certify that the organisation I represent has the financial and operational capacity to carry out the proposed project.

I declare that:- the organisation I represent has not received any other Union funding to carry out the

action that is the subject of this grant application;- I am fully aware that my organization is not entitled to receive more than one grant from

the European Union Budget for the action covered by this application and will therefore withdraw any application for any other grant from the European Union Budget should this application be successful, or will withdraw this application should any other application be successful.

- that the information contained in the application forms and annexes is complete and correct, according to the terms defined in the guidelines for this Call for Proposals.

I acknowledge that according to Article 131 of the Financial Regulation of 25 October 2012 on the financial rules applicable to the general budget of the Union (Official Journal L 298 of 26.10.2012, p. 1) and Article 145 of its Rules of Application (Official Journal L 362, 31.12.2012, p.1) applicants found guilty of misrepresentation may be subject to administrative and financial penalties under certain conditions.

Name / first name:

Title or position in the applicant organisation:

Signature [and official stamp] of the applicant:

Date:

Your reply to the grant application will involves the recording and processing of personal data (such as your name, address and CV), which will be processed pursuant to 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 indicated otherwise, your replies to the questions in this form and any personal data requested are required to assess your grant application in accordance with the specifications of the call for proposals and will be processed solely for that purpose by [entity acting as data controller]. Details concerning the processing of your personal data are available on the privacy statement at the page: http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf. Your personal data may be registered in the Early Warning System (EWS) only or both in the EWS and Central Exclusion Database (CED) by the Accounting Officer of the Commission, should you be in one of the situations mentioned in: - the Commission Decision 2008/969 of 16.12.2008 on the Early Warning System (for more information see the Privacy Statement on http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm ), or- the Commission Regulation 2008/1302 of 17.12.2008 on the Central Exclusion Database (for more information see the Privacy Statement on http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE )

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V.2. DECLARATION BY THE PARTNER/AFFILIATED ENTITY (IF ANY)

I, the undersigned, ….., authorised to represent the partner…….., hereby request from the Commission a grant of EUR …. with a view to implementing the action on the terms laid down in this application.

I certify on my honour that the organisation I represent is not in one of the following situations which would exclude it from receiving Union grants:

a) is bankrupt or being wound up, is having its affairs administered by the courts, has entered into an arrangement with creditors, has suspended business activities, is the subject of proceedings concerning those matters, or is in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

b) has been convicted of an offence concerning professional conduct by a judgment of a competent authority of a Member State which has the force of res judicata;

c) has been guilty of grave professional misconduct proven by any means which the Commission can justify including by decisions of the European Investment Bank and international organisations;

d) is not in compliance with all its obligations relating to the payment of social security contributions and the payment of taxes in accordance with the legal provisions of the country in which it is established, with those of the country of the authorising officer responsible and those of the country where the action is to be implemented;

e) has been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation, money laundering or any other illegal activity, where such activity is detrimental to the Union's financial interests;

f) is subject to an administrative penalty for being guilty of misrepresenting the information required as a condition of participation in a procurement procedure or another grant award procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts or agreements covered by the Union's budget.

I also declare that the organisation I represent:

g) has no conflict of interests in connection with the grant; a conflict of interests could arise in particular as a result of economic interests, political or national affinity, family, emotional life or any other shared interest;

h) will inform the Commission, without delay, of any situation considered a conflict of interests or which could give rise to a conflict of interests;

i) has not granted and will not grant, has not sought and will not seek, has not attempted and will not attempt to obtain, and has not accepted and will not accept any advantage, financial or in kind, to or from any party whatsoever, where such advantage constitutes an illegal practice or involves corruption, either directly or indirectly, inasmuch as it is an incentive or reward relating to the award of the grant;

j) provided accurate, sincere and complete information within the context of this grant award procedure.

I declare that the organisation I represent is fully eligible in accordance with the criteria set out in the specific call for proposals and in particular, that the it is owned and continues to

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be owned, whether directly or by majority shareholding, by nationals from the member States of the European Union.

I certify that the organisation I represent has the financial and operational capacity to carry out the activities it will have to implement in the proposed project.

If selected to to be awarded a grant, the organisation I represent accepts the standard conditions as laid down in the grant agreement.

I declare that:- the organisation I represent has not received any other Union funding to carry out the

action that is the subject of this grant application;- I am fully aware that my organization is not entitled to receive more than one grant from

the European Union Budget for the action covered by this application and will therefore withdraw any application for any other grant from the European Union Budget should this application be successful, or will withdraw this application should any other application be successful.

- that the information contained in the application forms and annexes is complete and correct, according to the terms defined in the guidelines for this Call for Proposals.

Name / first name:

Title or position in the applicant organisation:

Signature [and official stamp] of the applicant:

Date:

Your reply to the grant application will involves the recording and processing of personal data (such as your name, address and CV), which will be processed pursuant to 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 indicated otherwise, your replies to the questions in this form and any personal data requested are required to assess your grant application in accordance with the specifications of the call for proposals and will be processed solely for that purpose by [entity acting as data controller]. Details concerning the processing of your personal data are available on the privacy statement at the page: http://ec.europa.eu/dataprotectionofficer/privacystatement_publicprocurement_en.pdf. Your personal data may be registered in the Early Warning System (EWS) only or both in the EWS and Central Exclusion Database (CED) by the Accounting Officer of the Commission, should you be in one of the situations mentioned in: - the Commission Decision 2008/969 of 16.12.2008 on the Early Warning System (for more information see the Privacy Statement on http://ec.europa.eu/budget/contracts_grants/info_contracts/legal_entities/legal_entities_en.cfm ), or- the Commission Regulation 2008/1302 of 17.12.2008 on the Central Exclusion Database (for more information see the Privacy Statement on http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE )

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ANNEX

CHECK-LIST FOR APPLICANTS

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

The project budget (Annex C) has been duly filled in and is attached.

The project work timeline containing detailed production and delivery schedule enabling the Commission to identify key steps in the progress of the action is attached.

Letters of commitment by co-financiers have been included with the application form.

In case of a consortium - letters from partners confirming their participation to the project.

Legal details have been included in the Legal Entity Form(s) annexed.

Bank details have been included in the Bank Account Form(s)

Balance sheets or extracts from balance sheets for the last year for which accounts have been closed have been included with the application form.

Profit and loss account for the last financial year for which the accounts have been closed has been included with the application form.

Audit report by an approved external auditor on the accounts of the last financial year available has been included with the application form

Declaration(s) (part V) has/have been dated and signed

If applicable - declaration of the co-producers designing the applicant producer

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as the delegate producer in the case of grant award has been provided

A declaration concerning the rights to the work: - if the project is an original work, a declaration by the author and the applicant producer certifying that the work does not infringe the rights of any third party - if the project is an adaptation upon copyrighted material, a contract between the rights holder or agent and the applicant producer.

Evidence concerning applicants compliance with eligibility criterion (d) is enclosed.

Evidence concerning applicants operational capacity:- CVs of team - List of previous relevant experience- Logistic and managerial capacity to undertake the project within stated

parameters.

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