Application Form
Project title
Lead Beneficiary
Priority axis no.
Specific objective
Type of project (soft/hard)
Application FormforINTERREG V-A Romania-Bulgaria Programme
Project registration [to be filled in by the Joint
Secretariat]Project number: ________________(filled in by the Joint
Secretariat)Registration number and date: ______/___________(filled
in by the Joint Secretariat)
Registered by: __________________PRO-ETC Code:
_________________________________
OPIS of the Application Form and annexes
No.Form codeDocumentFrom pageTo page
1. A.0.Application Form
2. A.1.Declaration of submission
3. A.2.Legal documents of the applicants
4. A.3.Mandates of delegation
5. A.4.Declarations of Eligibility
6. A.5.Declarations of Commitment
7. A.6.Partnership declarations
8. A.7.Cost-Benefit Analysis
9. A.8.Documents certifying the right of
property/concession/administration/rent/loan on the land and/or
building (if the case)
10. A.9.Feasibility studies / equivalent technical documents (if
the case)
11. A.10.Urban planning permit (if the case)
12. A.11.Environmental agreement (if the case)
13. A.12.Environmental Impact Survey (if the case)
14. A.13.Traffic study (if the case)
15. A.14.Environmental Impact Study (if the case)
Note: additional documents relevant for project assessment can
be added!1. Project identification1.1. Project Full Name
Acronym (short title or abbreviation)
Programme priority axis
Programme priority specific objective
Lead Beneficiary (LB)
Number of beneficiaries (including LB)[maximum 5!]
Project duration (number of months)
1.2. Project summaryPlease give a short overview of the project
(in the style of a press release) and describe: the problem youre
addressing the objective youre aiming for, budget how you are going
to achieve the objectives (main activities) the result youre going
for (and how is that related to the Programme indicators)
[max. 1500 characters]
1.3. Applicant informationRole of the beneficiary in the project
[Lead beneficiary / Beneficiary]
Organization name in native language and abbreviation
Organization name in English and abbreviation
Legal Status[public law body /private law body]
Type of beneficiary
Country[Romania/Bulgaria]
County/District
Town/city
Address
Post Code
Complete name of the Legal representative (First name(s) and
last name(s))
Legal representative (Position)
Contact person(Name)
Telephone
Fax
E-mail
Website
Fiscal Code
Is your organization entitled to recover VAT based on national
legislation for the activities implemented in the
projects?No/yes/partly
If partly, please indicate the activities for which VAT is
recoverable
Object of activity[max. 500 characters]
Relevance of the beneficiary for the field addressed by the
project Which are the applicants thematic competences and
experiences relevant for the project? [max. 750 characters]
Previous EU financing experience of the beneficiary list all
projects relevant for the field addressed by the project, if any
(only projects started after 1 January 2007)
CBC Programmes 2007-2013For each project:1. Programme that
awarded the financing2. project name3. project MIS code/reference
number
Other EU funded projectsFor each project (maximum 3):1.
Programme that awarded the financing 2. project name3. project
MIS/SMIS code/reference number4. Start date and end date of the
project5. Project partners6. Project objectives and activities 7.
Total eligible value in euro (for finalized projects: total
eligible value after project implementation - financial execution;
for ongoing projects: total contract eligible value)
Please repeat the table for each project beneficiary!
2. Project description2.1. Problems to be tackledWhat are the
common territorial challenges that will be tackled by the project?
Please describe the relevance of your project for the programme
area in terms of common challenges and opportunities addressed.
[max. 1500 characters]
2.2. Project objectives and expected results Project main
objective(s) and expected result(s)Contribution to Programme result
indicators
Specify the project main objective(s) and expected results [max.
500 characters]Describe the link with the relevant programme result
indicatorProgramme result indicator your project will contribute
toContribution to the achievement of programme result indicator
[max. 300 characters][Name - from the list of programme results
indicators corresponding to the selected programme priority
axis][max. 500 characters for quality indicators / just indicate
the contribution for quantitative indicators]
2.3. Project activities Activity NumberActivity titleActivity
start monthActivity end monthActivity responsible
beneficiaryInvolved beneficiaries
A1Project preparationPP1, PP2,PP3PP1, PP2, PP3
Please describe the resources each beneficiary used for this
project activity. [max. 500 char/partner]
Present the activity - explain why it is necessary for the
project.[max. 1000 char]
Activity NumberActivity titleActivity start monthActivity end
monthActivity responsible beneficiaryInvolved beneficiaries
A1, A2, An - continuous (please note that information and
publicity is a mandatory activity)1, 2, 3Month 1-month of signing
the financing contract1, 2, 3
Please describe the resources each beneficiary is planning to
use for implementing this project activity. [max. 500
char/partner]
Description of the activity (explain why it is necessary for the
project; explain the necessity of envisaged costs for implementing
this activity - for necessary equipment, services and works detail
according to the table below; for other necessary costs provide
explanation)
[max. 2000 char]
Description of the main equipment and services purchased (if the
case)
Crt. no.Name of the equipment/serviceDescriptionResponsible
beneficiaryQuantity
E1, E2 Continuous numbering at project levelEquipment[one row
for each equipment, repeating per partners, if the same equipment
is purchased by more than one partner]Please list all technical
specifications and permits (if the case) required for the purchase
of the equipment, according to the national legislation. If they
are available, attach them to this Application Form; otherwise
indicate when you expect them to be available.[max. 1000
characters]
S1, S2Continuous numbering at project levelServices[one row for
each service repeating per partners, if the same service is
purchased by more than one partner]List the planned contracts with
external experts and service providers, and describe their links to
project activities. The need for external experts and services
needs to be duly justified. [max. 1000 characters]
Description of the work (if the case)
Crt no.Name of the workDescriptionResponsible beneficiary
W1, W2continuous numbering at project levelInvestment[one row
for each investment, repeat per partners, if the same type of work
is carried out by more than one partner]Please provide an overall
description of the work, including technical documentation as
annex.Explain the need for the investment to achieve project
objectives and results. Describe clearly the cross-border relevance
of the investment. [max. 1000 characters]
LocationLocation of the physical investment; concrete address
where the investment will take place (if possible) [max 100
characters]
Risks associated with the investmentDescription of the risks
associated with the work, go/no-go decisions, etc. (if any)[max.
1000 characters]
Investment documentation(incl. specification and
requirements)Please list all technical specifications and
permissions (e.g. feasibility study, technical project) required
for the work according to the respective national legislation.
Attach the complete Feasibility study (or the equivalent technical
documents) to this Application Form!! [max. 1000 characters]
OwnershipWho owns the site where the work is located?Who will
retain ownership of the work at the end of the project?Who will
take care of maintenance of the work? How will this be done?[max.
1000 characters]
Please repeat the table for each activity! Please make sure all
costs in the budget are reflected in the description of activities
(why these costs are necessary, how they contribute to the
implementation of activities and thus to the project).
Activities outside the programme area[footnoteRef:2] [2: All
activities to be carried out outside the fund eligible area should
be described (including activities by partners located inside and
partners located outside the programme area). In line with Art 20
ETC Regulation, the benefits of any activity carried out outside
the programme area need to be justified.]
If applicable, please list activities to be carried out outside
the programme area. Describe how these activities will benefit the
programme area.
Max. 1500 char.
Total budget of activities to be carried out outside the
programme area (indicative)Total EURmanually inserted
P1EUR
P2.EUR
2.4. Project outputs:Contribution to programme outputs
Please describe how will you contribute to the achievement of
the programme output indicator(s)Choose the programme output
indicator(s) to which the activity will contributeContribution to
the achievement of programme output indicator
[max. 500 char][from programme output indicators relevant for
the priority axis/specific objective]Quantify your contribution
[max. 500 char][from programme output indicators relevant for
the priority axis/specific objective]Quantify your contribution
2.5. Target groups: Which are the target groups that will
benefit from project results and outputs? Select only relevant
target groups Indicate size andlocation of selected targetgroupsHow
does the project tackle the needs of selected target group?
(e.g.: Individual citizens, Private companies, NGOs, Public
sector, Educational and research intuitions)[one row for each
target group chosen][max. 750 char]
2.6. Project coherence with other programmes/strategies/projects
2.6.1. How does the project contribute to the wider strategies and
policies?Please describe the projects contribution to relevant
European, national, regional or local strategies and policies; in
particular, those concerning the project or programme area.
Indicate if the project contributes to the following strategies
and describe in what way.
EU 2020 Strategy|_|[max. 300 char]
EU Strategy for the Danube Region|_|[max. 300 char]
Blue growth Strategy|_|[max. 300 char]
Other EU/national/regional/local
programmes/strategies/initiatives|_|[max. 300 char]
2.6.2. Does the project build on available outputs and results
of other implemented initiatives? Are there synergies with past or
current EU and other projects or initiatives the project makes use
of?Please describe the experiences/lessons learned the project
draws on, and other outputs and results of past implemented
initiatives the project capitalises on, if they exist.
[max. 1500 char]
2.7. Project coherence with horizontal themesPlease indicate
which type of contribution to horizontal principles applies to the
project, and justify the choice.
Type of contributionDescription of the contribution
Equal opportunities and non-discrimination[Choose from: neutral,
positive effects][max. 1500 char]
Equality between men and women [Choose from: neutral, positive
effects][max. 1500 char]
Sustainable development[Choose from: neutral, positive
effects][max. 1500 char]
2.8. Revenue generation
Is your project revenue generating? Yes / NoIf yes, please offer
relevant details, including analysis and amount resulted as revenue
generated (using maximum 2 decimals). [max. 2500 char]
3. Financial information
Application Form March 2015
1
3.1. BudgetPlease choose one of the two tables below to fill in,
according to the type of project hard or soft.The table will be
filled-in in Euro, using maximum 2 decimals.The nationality of each
beneficiary must be selected (choosing from RO or BG) and amounts
will be filled-in for each beneficiary for each of the following
categories of expenditure: Travel and accommodation; External
expertise and services, with mentioning separately the amounts for
external expertise and services related to the project management
(including external expertise related to the organisation of the
public procurements for the project, services related to the
financial and technical reporting for the project), if any;
Equipment; Infrastructure and works and Project preparation. The
other cells in the table will be generated automatically based on
your inputs in the table.Amounts filled-in in the budget will
exclude net revenues, in case of revenue generating
projects.Amounts will include VAT corresponding to eligible
expenditure, if eligible. Please observe the list of eligible
expenditure from the Applicant Guide and the maximum Ceilings for
expenditure included in Annex C to the Applicants Guide!
3.2 Non eligible expenditureLead BeneficiaryBeneficiary
2Beneficiary 3Beneficiary 4Beneficiary 5
Non-Eligible expNon-Eligible expNon-Eligible expNon-Eligible
expNon-Eligible expTotal Non-Eligible exp
AmountAmountAmountAmountAmountSum
Explanations for the non-eligible expenditure, if such
expenditures exist (including correlation with the Feasibility
study, where applicable)texttexttexttextText
Maximum 2 decimals will be used!
3.3. Financing history3.3.1. Has this project been submitted
before for financing in another programme either as such, parts of
it or as part of a bigger project? Yes / No
If Yes, please fill in the table below:Programme
Source of Financing
Date of submission
Current status (under evaluation / approved / rejected)[max. 500
char]
Other relevant information[max. 1000 char]
4. Exit/continuation strategy Sustainability and transferability
of project output and resultsPlease describe what impact your
project may have five years after the project has ended. The kind
of follow-up actions that are planned (i.e., exit/continuation
strategy) and what are the chances for them to be achieved should
be also stated here. In general, it is expected that the results of
a project would outlive the lifetime of the project itself. Based
on the results of this projects, the applicants should estimate
what other projects or activities can be developed in the benefit
of the communities in the cross-border area. [max. 3000
characters]
AnnexesThe following documents will be uploaded in the system
(scanned versions of the documents)Indicative list: 1. Declaration
of submission of the application form 2. Legal documents of the
applicants 3. Mandates of delegation (in case the application form
is not signed by the legal representative of the Lead Beneficiary)
4. Declarations of Eligibility 5. Declarations of Commitment 6.
Partnership declarations 7. Cost-Benefit Analysis (if the case) 8.
Documents certifying the right of property/ concession/
administration/ rent/ loan on the land and/or building (if the
case) 9. Feasibility studies / equivalent technical documents (if
the case)10. Urban planning permit (if the case) 11. Environmental
agreement (if the case) 12. Environmental Impact Report (if the
case) 13. Traffic study (if the case) 14. Environmental Impact
Study (if the case) 15. Other relevant documents (e.g. price offers
)
Sheet1
HARD PROJECTSROBGHARD PROJECTSTOTALVerification allertsLead
BeneficiaryBeneficiary 2Beneficiary 3Beneficiary 4Beneficiary
5BGROBGROBG! Amounts will exclude net revenues - for revenue
generating projects!Percentages and rates (%)Total Net Eligible
Expenditure% from total budget at project levelNet eligible
expenditureNet eligible expenditureNet eligible expenditureNet
eligible expenditureNet eligible expenditureTravel and
accommodation10.0094.34%10.00External expertise and
services0.000.00%Out of which external expertise and services
related to the project
management0.000.00%Equipment0.000.00%Infrastructure and
works0.000.00%TOTAL (calculation basis)
10.0094.34%10.000.000.000.000.00Project preparation (maximum 10% of
calculation basis)10.00%0.000.00%OKStaff costs - flat rate of
maximum 15% of calculation basis for soft projects and maximum 5%
of calculation basis for hard projects, calculated according to the
Applicant Guide 5.000.504.72%0.500.000.000.000.00Office and
administrative costs flat rate of 5% of calculation basis for soft
projects and 1% of calculation basis for hard
projects1.00%0.100.94%0.100.000.000.000.00TOTAL project net
eligible budget10.60100.00%!!Below minimum
allowed10.600.000.000.000.00
Total ERDF9.0185.00%ERDF9.010.000.000.000.00Total National
Cofinancing, out of which:1.3813.00%National Cofinancing, out of
which:1.380.000.000.000.00Total RO State Budget0.00RO State Budget
0.000.000.000.000.00Total BG State Budget 1.38BG State Budget
1.380.000.000.000.00Total Own Contributions0.212.00%Own
Contributions0.210.000.000.000.00
Sheet1
HARD PROJECTSROBGSOFT PROJECTSTOTALVerification allertsLead
BeneficiaryBeneficiary 2Beneficiary 3Beneficiary 4Beneficiary
5ROBGBGROBG! Amounts will exclude net revenues - for revenue
generating projects!Percentages and rates (%)Total Net Eligible
Expenditure% from total budget at project levelNet eligible
expenditureNet eligible expenditureNet eligible expenditureNet
eligible expenditureNet eligible expenditureTravel and
accommodation1,000.0083.33%1,000.00External expertise and
services0.000.00%Out of which external expertise and services
related to the project management0.000.00%Equipment0.000.00%SOFT
PROJECTInfrastructure and worksTOTAL (calculation basis)
1,000.0083.33%1,000.000.000.000.000.00Project preparation (maximum
10% of calculation basis)10.00%0.000.00%OKStaff costs - flat rate
of maximum 15% of calculation basis for soft projects and maximum
5% of calculation basis for hard projects, calculated according to
the Applicant Guide 15.00150.0012.50%150.000.000.000.000.00Office
and administrative costs flat rate of 5% of calculation basis for
soft projects and 1% of calculation basis for hard
projects5.00%50.004.17%50.000.000.000.000.00TOTAL project net
eligible budget1,200.00100.00%!!Below minimum
allowed1,200.000.000.000.000.00
Total ERDF1,020.0085.00%ERDF1,020.000.000.000.000.00Total
National Cofinancing, out of which:156.0013.00%National
Cofinancing, out of which:156.000.000.000.000.00Total RO State
Budget156.00RO State Budget 156.000.000.000.000.00Total BG State
Budget 0.00BG State Budget 0.000.000.000.000.00Total Own
Contributions24.002.00%Own Contributions24.000.000.000.000.00
