APPLICATION FORM - British Council · · 2016-06-27APPLICATION FORM Cultural Protection Fund PAGE...

APPLICATION FORM Cultural Protection Fund

PAGE 1

June 2016

APPLICATION FORMCultural Protection Fund

INTRODUCTIONThis is the Application Form for the initial round of the Cultural Protection Fund, which is for applicants with existing partnerships in target countries only, and can be used to apply for both small (<£100,000) and large (>£100,000) grants. Please note that this form must be filled in on a computer and submitted electronically (hand written applications will not be accepted). It is essential that you read the Application Guidance on the Cultural Protection Fund website in full before completing this form. Detailed instructions on how to complete each question are provided in Part five: Application form help notes of the Application Guidance. Please provide concise answers to all questions. Once you have completed the application

form, submit it with the attached supporting documents to [email protected] (with ‘application form’ in the subject line).

In no more than 15 words, please choose a title for your project.

CONTENTSIntroduction ............................................................1

Section one: Your organisation ................2

Section two: Project location and partners ...................5

Section three: Cultural protection focus ...........................14

Section four: The project ...........................17

Section five: Project outcomes ...........................................20

Section six: Project management and delivery .......................24

Section seven: After the project ends ................................28

Section eight: Project costs ...................32

Section nine: Supporting documents ..............................40

Section ten: Declaration .............................41

mailto:cpfapplications%40britishcouncil.org?subject=Application%20form

APPLICATION FORM Cultural Protection Fund PAGE 2

SECTION ONE: Your organisation

1a. Legal name and address of your organisation

Organisation name:

Building name:

Street:

Town:

City:

Postcode:

1b. Details of main contact person

Name:

Fill in as appropriate. This person must have official permission from your organisation to be our main contact. We will send all correspondence about the application to this person.

Street:

Town:

City:

Postcode:

Telephone:

Email:


1c. Describe your organisation’s main purposes and regular activities.

Describe the day-to-day business of your organisation.

Maximum 100 words.

1d. Which of the following best describes the legal status of your organisation?

An academic institution

Tick the box which best describes the legal status of your organisation. Please note that sole traders are not eligible to apply.

A public sector organisation

A charity or voluntary organisation

A non-governmental organisation (NGO)

A company

Other (please specify):

1e. For organisations not in the public sector:Describe the size and staff structure of your organisation.

Only applicable to organisations not in the public sector.

Maximum 100 words.

If applicable, how many board members does your organisation have?

How much did your organisation spend in the last financial year?


1f. If your organisation is any of the following, please provide the information shown.

Company – give registration number

Registered Charity in England, Scotland or Wales – give registration number

Charity recognised by HM Revenue and Customs in Northern Ireland – give reference number

1g. Is your organisation VAT registered?

Yes No

If yes, please provide your VAT number.

1h. Where did you hear about the Cultural Protection Fund?

Cultural Protection Fund website

Local British Council office

Department for Culture, Media and Sport



SECTION TWO: Project location and partners

2a. Which of the Cultural Protection Fund’s target countries will benefit from your project?

Afghanistan Occupied Palestinian Territories

Applications to the Cultural Protection Fund must demonstrate intent to benefit one or more of these countries as their main aim. Tick the country or countries which will benefit directly from your project and indicate whether any part of your project will be delivered in the UK.

Egypt Sudan

Iraq Syria

Jordan Tunisia

Lebanon Turkey

Libya Yemen

Will any part of your project be delivered in the UK?

Yes No


2b. Legal name and address of your local partner organisation(s)Partner 1

Applicants are required to deliver the project in partnership with a relevant organisation in one of the Fund’s target countries. Please indicate the legal name and address of your proposed local partner organisation(s).

Name:

Street:

Town:

City:

Postcode:

Country:

Partner 2

Name:

Street:

Town:

City:

Postcode:

Country:

Partner 3

Name:

Street:

Town:

City:

Postcode:

Country:


2c. Details of main contact person from local partner organisation(s)Partner 1

Fill in as appropriate. This person may be contacted by the British Council as part of the assessment process.

Name:

Street:

Town:

City:

Postcode:

Country:

Telephone:

Email:

Partner 2

Name:

Street:

Town:

City:

Postcode:

Country:

Telephone:

Email:

Partner 3

Name:

Street:

Town:

City:

Postcode:

Country:

Telephone:

Email:


2d. Describe the main purposes and regular activities of your local partner organisation(s).

Describe the day-to-day business of your local partner organisation(s).

Maximum 300 words.


2e. Which of the following best describes the legal status of your local partner organisation(s)?

Partner 1

Select the box which best describes the legal status of your local partner organisation(s). In general there is no restriction on the type of organisation you can partner with; the partnership will be assessed based on its potential for achieving Fund outcomes.





A company


Partner 2





A company


Partner 3





A company



2f. Is/are your local partner organisation(s) in touch with their local British Council office?

Yes No

If yes, please indicate the name of your partner’s contact and the location of their local British Council office.

Partner 1

Contact name:

Location of British Council office:

Partner 2

Contact name:


Partner 3

Contact name:



2g. Do you have an established working relationship with your local partner organisation(s)?

Partner 1

Due to time restrictions, applicants for the initial round of funding are required to have established working relationships with proposed project partners. Please describe the nature of your relationship with the partner(s), any work you have undertaken together and any other relevant work you or your partner(s) has/have carried out. Include approximate start and end dates and budgets for all projects. Applicants will be required to attach a partnership agreement signed by all project partners at full application stage.

Maximum 300 words in each box.

Yes No

If yes: describe the nature of the work you have carried out with this/these partner(s) and any other relevant work that you or your partner(s) has/have carried out in this country or region.


Partner 2 Maximum 300 words.

Yes No



Partner 3 Maximum 300 words.

Yes No



SECTION THREE: Cultural protection focus

3a. Describe the cultural heritage which your project aims to protect.

The Fund is targeted at cultural heritage under threat in one or more of the Fund’s target countries. Cultural heritage includes many different things from the past that communities value and want to pass on to future generations, for example:

• archaeological sites and monuments

• collections of objects, books or documents in museums, libraries or archives

• historic buildings

• historic landscapes, gardens and parks

• cultural traditions such as stories, festivals, crafts, music, dance and costumes

• histories of people, communities, places and events

• the heritage of languages and dialects

• people’s memories and experiences (often recorded as ‘oral history’).

Provide a description of the cultural heritage your project aims to protect. If your project focuses on training people to manage, promote or look after cultural heritage, describe the particular skills that are the focus of this project.

Note relevant heritage designations (if any) and provide an explanation of what is important about the heritage, including whether it is:

• a source of evidence or knowledge

• of aesthetic, artistic, architectural, historic, natural or scientific interest

• of social or community value

• of economic value.

Explain who values the cultural heritage, such as the local community, visitors and/or experts.

Maximum 300 words.


3b. Describe the threat faced by the cultural heritage.

Describe the nature of the threat faced by the cultural heritage. For example, physical cultural heritage in conflict zones may be at risk of damage or destruction due to armed conflict; theft, pillaging or misappropriation; or vandalism. Intangible cultural heritage may be at risk of loss due to the fragmentation of communities or other events associated with conflict. Other examples of risks to cultural heritage include poor management, inadequate storage and/or documentation and a lack of specialist skills relating to the care and management of cultural heritage.

Maximum 300 words.


3c. Does your project involve work to physical heritage such as buildings, monuments or collections?

Yes No

Fill in as appropriate. Applicants are required to attach proof of ownership or legal permission to carry out any proposed physical work. If this is not available at the time of application, it will be required before permission to start the project is granted. Please note that due to the scope of the fund, capital projects involving significant amounts of redevelopment or new building work are unlikely to be a high priority for funding.

First box – maximum 50 words.

Second box – maximum 100 words.

If yes: What is the name of the cultural heritage asset and where is it located or held?

If yes, does your partner organisation own the cultural heritage asset outright?

Yes No

If no, does your partner organisation have legal permission to carry out the proposed work?

Yes No

If no, when will this permission be in place?


SECTION FOUR: The project

4a. Describe what your project will do.

Provide a detailed summary of what your project will do. Describe project activities and any outputs your project will produce. Where possible, include target numbers. For any physical work, attach the relevant specification or briefs.

Use the project plan template in Appendix 2 to produce a detailed plan for your project.

Maximum 500 words.


4b. Describe the needs that your project will address.

Please ensure that you answer the following questions in your response:

• How critical is the need for cultural protection? What will happen to the cultural heritage if the project does not go ahead?

• Describe any social needs your project responds to, such as any problems with how people currently engage with and understand their cultural heritage.

• Describe any economic needs your project responds to, such as any barriers to the cultural heritage bringing benefit to the local economy.

• Does your project fit with any local strategies or wider initiatives (including any relevant international cultural protection programmes)?

• Are there any other organisations already delivering the type of work you propose to carry out?

• What other sources of funding have you considered for this project?

Maximum 500 words.


4c. What work and/or consultation have you and your partner(s) undertaken to prepare for this project?

Tell us about the options you have considered, and why this project is a suitable response to the problems and opportunities you have identified.

Tell us about any consultation you and your partner(s) have undertaken (for example, with experts, others working in the field, members of the community and/or potential project participants) and how this has shaped your project proposals.

A statement outlining the perceived local need for the project should be provided by the local partner(s) and attached to this application.

Maximum 300 words.


SECTION FIVE: Project outcomes

5a. Which of the Cultural Protection Fund’s three outcomes will your project achieve and how

Cultural protection

Referring to the outcomes table in Part one of the Application Guidance, tick the relevant outcomes for your project and explain how each outcome will be achieved (remember that all projects must contribute towards the cultural protection outcome). You should make reference to all of the relevant sub-outcomes listed in the table.

When assessing your application, we will take into account the extent of the impact likely to be made, not the number of outcomes you will achieve beyond the minimum requirement.

Maximum 300 words in each box.


Training and capacity building


Advocacy and education

5b. Does your project involve cultural heritage that attracts visitors?

Yes No

If the site or facility involved in your project is part of a bigger attraction (for example, a gallery within a larger museum), only give visit numbers for the part involved in the project).

If yes: how many visits have you received in the last year?

How many people do you expect will visit in the first year after project completion?


5c. If applicable, how many people from target countries will be trained as part of your project?

Training includes any structured programme of on-the-job training, skill-sharing, work-based learning and work experience. Only include training received by people from target countries.

5d. If applicable, how many volunteers from target countries do you expect will contribute to your project?

Fill in as appropriate. Only include volunteers from target countries.

5e. If applicable, how many full-time equivalent posts will you create to deliver your project?

If your project involves part-time posts you should include these as part of the number (e.g. 2 x 0.5 FTE posts = 1 FTE post).


SECTION SIX: Project management and delivery

6a. Who are the main people responsible for delivering the project?

Provide detailed information about the team that will deliver your project, including:

• Relevant technical or specialist skills and experience that will ensure that the project follows best practice in cultural heritage protection, training, advocacy and/or education.

• Who is responsible for making decisions and approving changes to your project. Describe the reporting structure and how often meetings will take place.

• How you will choose staff, services and goods needed during the project (see Buying goods, works and services in Part three of this guidance).

You will also need to attach job descriptions for any new posts and briefs for any consultants. A project management structure is also required for large grants (>£100,000).

Maximum 400 words.


6b. When do you expect your project to start and finish?

Project start date: MM/YYYY

Fill in the start and finish dates for your project. Provide a detailed timetable for your project. It should contain all parts of your project, such as choosing consultants, any further research or consultation, design stages, reviews, activities and evaluation.

All projects must be completed and grants paid by April 2020. Project activity should therefore be finished by the end of January 2020 in order to allow for the completion of evaluation and the submission of final invoices and completion report.

Project end date: MM/YYYY

6c. Tell us about the risks to your project and how they will be managed.

Risk Likelihood (H/M/L)

Impact (H/M/L)

Mitigation Risk owner



Impact (H/M/L)


Fill in the risk table to provide a realistic assessment of the risks your project may face so that you are in a good position to manage them. Rate the likelihood of these risks as high (H), medium (M) or low (L).

The risks could be:

• technical

• financial

• organisational

• economic

• social

• legal

• political

• related to security and the volatility of operating environments.


6d. Provide a brief description of the due diligence you will undertake to ensure against fraudulent use of any funds you receive from the Cultural Protection Fund.

This may refer to any existing procedures within your organisation or any additional precautions you will take when spending the funding.

Maximum 100 words.


SECTION SEVEN: After the project ends

7a. How will you maintain the outcomes of your project after the grant ends and meet any additional running costs?

Provide detailed information about how the outcomes of the project will be managed and maintained once the project is completed (for projects involving physical works or the creation of digital heritage assets, a management and maintenance plan will be a required output for the project, and costs for this can be included within the project).

If relevant, explain how the project will be financially sustainable and any changes to the management or governance of the beneficiary organisation that will help to sustain the outcomes of the project. For large grants (>£100,000), you should provide income and spending forecasts for five years following project completion.

Maximum 300 words.


7b. Tell us about the main risks facing the project after it has been completed and how they will be managed.


Impact (H/M/L)




Impact (H/M/L)


Fill in the risk table (see question 6c).


7c. How will you evaluate the success of your project from the beginning and share the learning?

You are required to evaluate your project in line with the guidance provided by the Fund. Describe your proposed evaluation approach and who will have overall responsibility for this. We are committed to sharing the experience of the Fund and its projects with the wider sector. Applications should therefore include specific proposals for sharing experience and lessons learned as widely as possible.

Maximum 200 words.


SECTION EIGHT: Project costs

8a. Fill in the cost table with your total project costs.Capital costs

Cost heading Description Cost (excluding VAT) (£)

Irrecoverable VAT (£)

Total (£)

Repair, conservation or restoration work

Other capital work

Equipment and materials

Other

Professional fees relating to any of the above

Total capital costs


Activity costs



Total (£)

Additional staff costs

Training for staff

Paid training placements

Training for volunteers

Travel for staff

Travel and expenses for volunteers


Activity costs



Total (£)

Equipment and materials

Other

Professional fees relating to any of the above

Total activity costs


Other costs



Total (£)

Recruitment

Publicity and promotion

Other

Full cost recovery

Contingency

Inflation

Total other costs

Total costs*


Use this table to provide a summary of the costs of your entire project. You will also need to provide a separate spreadsheet showing how these summary costs are broken down. When completing the table, you should only fill in the cost headings which are relevant to your project. Please read the following notes before filling in the table:

VAT (Value Added Tax)• If you are liable to pay VAT on certain costs

incurred in the UK, you should include irrecoverable VAT in the VAT column for all relevant costs. Do not include VAT in the cost column in column three.

• The British Council cannot provide advice on VAT liability. Any queries should be directed to HM Revenue and Customs.

• We cannot authorise the transfer of any part of the project costs to or from VAT. This means that if you underestimate VAT, you will have to pay the extra costs, and if your VAT status changes so that you can reclaim more than you expected, you will need to return the relevant portion to us.

CAPITAL COST HEADINGSRepair, conservation or restoration workIncludes the costs of work to repair, restore or conserve a heritage item or site.

Other capital workThis includes costs relating to other capital work, such as physically protecting or securing cultural heritage site or assets, producing new interpretation or displays and creating digital outputs.

Equipment and materialsThis includes all equipment and materials relating to repair, conservation and restoration work and any other capital work. Do not include materials relating to training and activities here.

OtherPlease list any other items that you consider to be capital costs.

Professional fees relating to any of the aboveThis includes any person appointed for a fixed fee to help with planning and delivering capital work in your project.

ACTIVITY COST HEADINGSAdditional staff costsThis may include the costs of new fixed-term contracts, freelance staff, extra hours for existing staff or the cost of filling a post left empty by moving an existing member of staff into a post created for the project. Do not include the costs of paying trainees here. Use a separate line for each new staff member in your separate costs spreadsheet.

Training for staffThis includes the cost of all trainers and resources needed to deliver activities to help staff gain new or increased skills.

Paid training placementsThis includes bursaries or payments to trainees, as well as all resources needed to deliver activities to help trainees gain new or increased skills.

Training for volunteersThis includes the cost of all resources needed to deliver activities to help volunteers gain new or increased skills.

Travel for staffThis may include the cost of travelling to a site or venue. Economy class should be booked for air travel, and standard class for train travel. Travel costs by car should be based on the appropriate rate per mile in the given country (45p a mile in the UK).

Travel and expenses for volunteersThis may include food, travel and any other expenses to ensure volunteers are not out of pocket. Travel costs by car should be based on the appropriate rate per mile in the given country (45p a mile in the UK).

Equipment and materialsThis includes the equipment and materials related to all learning, engagement and advocacy activities. Do not include materials relating to training here.

OtherInclude any other costs relating to activities here.

Professional fees relating to any of the aboveThis includes any person appointed for a fixed fee to help with planning and delivering the learning, engagement or advocacy activities of your project.

OTHER COST HEADINGSRecruitmentThis can include advertising and travel expenses.

Publicity and promotionThis includes promotional materials that relate directly to your project.

EvaluationYou must evaluate your project, and we recommend you allow sufficient budget for this process here. Staff in your organisation can do this, or you may want to employ someone to help. Evaluation costs should be approximately three per cent of your overall project costs. Further evaluation guidance will be provided to successful applicants.

OtherInclude any other costs. In your separate spreadsheet please include a clear description.

Full cost recoveryPlease read about Full Cost Recovery in Part one: Introduction of the Application Guidance.

ContingencyMake sure that you only include contingency here and not in the costs under each cost heading. Not all cost items will need a contingency. Your calculation for contingency should reflect:

• the degree of certainty with which you have arrived at your cost estimates

• the project timetable

• the risk in relation to your project location and the type of project you are carrying out.

You will need to seek approval from us for use of contingency during project delivery.

InflationYou should include an allowance for inflation for any items that may increase in cost over the period of your project. The calculation must be as realistic as possible and relate to your project timetable.


8b. Fill in the income table with any partnership funding being contributed to the project.

Income

Source of funding Description Secured? Date when the funding will be secured

Value (£)

Yes No

/

/

Yes No

/

/

Yes No

/

/

Yes No

/

/

Yes No

/

/

Yes No

/

/

Cultural Protection Fund grant request

Total income*

*Total cost and income must match exactly

It is not required, but you are encouraged to make a contribution to your project if possible. This can be from your own funds or other grant sources. You should only

include partnership funding sources which will be secured before your proposed project start date. If the funding is not secured now, indicate the date

when it will be secured. Your total project costs must match your project income.


8c. Please tell us about any non-cash contributions that will be made to your project.

If your project will benefit from any non-cash contributions, please list these costs and their approximate value. Non-cash contributions include items or service that you receive without charge, such as the use of a room or a donation of materials.

Maximum 100 words.

8d. Please tell us about any volunteer time that will be contributed to your project.

Include the number of days that volunteers will spend helping to deliver your project and the approximate value for this time. You should base this value on accepted rates for professional, skilled and unskilled labour in the relevant country (UK: professional – £350 per day, skilled – £150 per day; unskilled – £50 per day).

Maximum 100 words.


8e. How much of your grant money will be spent during each of the following financial years?

Financial year Total grant2016–17 2017–18 2018–19 2019–20

Total grant money claimed

£

£

£

£

£

*Financial year runs from April to March. Financial year 2016–17 means April 2016 to March 2017.

Indicate the amount of your total grant from us which will be drawn down during each relevant financial year.

You must attach a detailed cash flow profiling all expenditure and income across the relevant financial years. For multi-year projects, a cash flow for the first 12 months is acceptable. Please read Part three: Managing your grant of the Application Guidance for information on the timing and frequency of grant payments.


SECTION NINE: Supporting documents

9. Please attach all of the documents listed in this table which apply to your project.

Supporting information required for all applications

Additional requirements for large grants (requests >£100,000)

For all projects involving physical works or the creation of digital outputs

A copy of the applicant organisation’s governing document.

A detailed cost spreadsheet. A condition report (if applicable).

A copy of the applicant organisation’s accounts for the last financial year.

A project timetable. A specification (to RIBA work stage 3 or the equivalent) or relevant briefs, depending on the nature of the work.

A partnership agreement signed by the applicant organisation and named local partner(s).

A project management structure.

A relevant management and maintenance document (this can be produced as part of the project and may be included under project costs).

A statement outlining the perceived local need from the project (from the named local partner(s)).

Income and spending forecasts for five years following project completion (if applicable).

Proof of ownership or permission to carry out proposed work (if applicable).

A project plan (following the template in Appendix 3 of the application guidance).

N/A N/A

A project cash flow (profiled across financial years as per guidance).

N/A N/A

Briefs for internally and externally commissioned work.

N/A N/A

Job descriptions for new posts.

N/A N/A

A small selection of images that help illustrate your project. If your project involves physical heritage, please provide a selection of photographs, a location map and, if applicable, a simple site map or plan.

N/A N/A

Refer to the list of supporting documents and ensure that you attach all of the applicable documents for your project. There are additional requirements for large grants (>£100,000) and for projects involving physical works or the production of digital outputs. Applications will not be considered complete without all required attachments having been received by the application deadline. Documents should be submitted in digital formats as attachments to your application form email. If documents are too large to email, please use a file sharing service such as Dropbox.


SECTION TEN: DeclarationYou must read the Application Guidance on the Cultural Protection Fund website. By completing this Declaration, you are confirming that you have read and understood this guidance.

Freedom of Information and Data ProtectionThe British Council operates within the Freedom of Information Act 2000 and the Data Protection Act 1998. More information about these Acts can be found on the British Council website (https://www.britishcouncil.org/organisation/transparency/freedom-information and https://www.britishcouncil.org/privacy-cookies/data-protection). By completing this declaration, you are confirming that you understand our obligations under these Acts. You also agree that we will use the information in this application form and other information you give us for the following purposes:

• To decide whether to award you a grant.

• To provide copies to selected individuals or organisations who are helping us to assess or monitor the grant.

• To hold in a database and use for statistical purposes.

• If we offer you a grant, we will publish information about your organisation and the project activity we have funded.

• If we offer you a grant, you will support our work to capture and share learning about the Fund by participating in publicity activities and/or activities to share learning or to assisting with queries from potential applicants.

We may contact you from time to time to keep you informed about the work of the Cultural Protection Fund. Tick this box if you do not wish to be kept informed of our work.

Please read the following statements and tick the box below confirming your understanding and agreement:

The applicant organisation named in this application has given me the authority to complete this application on its behalf.

The activity in the application falls within the purposes and legal powers of the applicant organisation.

The applicant organisation has obtained professional advice where appropriate on State aid, and project activity in the application complies with State aid rules.

The applicant organisation has the power to both accept and pay back the grant if required.

If my organisation receives a grant, it will abide by the terms and conditions of the Grant Agreement and any relevant guidance issued by the Fund.

The local partner organisation(s) is/are fully aware of its/ their role in the project as described in this application.

Neither the applicant organisation or local partner organisation(s) are or may be the subject of a conflict of interest during the grant award procedure or during the lifetime of the grant.

In order to comply with UK government legislation, the British Council may at any point during the application process, carry out searches of relevant third party screening databases to ensure that neither the applicant institutions nor any of the applicants’ employees, partners, directors, shareholders is listed:

• as an individual or entity with whom national or supranational bodies have decreed organisations should not have financial dealings

• as being wanted by Interpol or any national law enforcement body in connection with crime;

• as being subject to regulatory action by a national or international enforcement body

• as being subject to export, trade or procurement controls or (in the case of an individual) as being disqualified from being a company director

• as being a heightened risk individual or organisation, or (in the case of an individual) a politically exposed person.

If the applicant or any other party is listed in a screening database for any of the reasons set out above, the British Council will assess the applicant as ineligible to apply for this grant call. The applicant must provide the British Council with all information reasonably requested by the British Council to complete the screening searches.

Once you have submitted your application by email, you will receive an automatic reply as confirmation of receipt of your application. Once your application has been logged you will receive correspondence containing your application reference number. This reference number should be mentioned in all communications regarding your application form.

I confirm that I agree with the above statements

Signed

Name

Organisation

Position

Date

https://www.britishcouncil.org/organisation/transparency/freedom-information

https://www.britishcouncil.org/organisation/transparency/freedom-information

https://www.britishcouncil.org/privacy-cookies/data-protection

https://www.britishcouncil.org/privacy-cookies/data-protection


State aid de minimis declaration (Only complete this section if you are applying for State aid under the de minimis regulation – please read Application Guidance first, which has links to the Department of Business, Innovation and Skills State aid guidance, and seek professional advice if necessary).

Under EC Regulation 1407/2013 (De Minimis Aid Regulation) as published in the Official Journal of the European Union 24 December 2013, the support you are applying for is a de minimis aid. There is a ceiling of €200,000 for all de minimis aid provided to any one organisation over a three fiscal year period (i.e. your current fiscal year and previous two fiscal years). Any de minimis aid provided to you under this scheme will be relevant if you wish to apply, or have applied, for any other de minimis aid. The value of the aid under this scheme is (or estimated to be by calculating the gross grant equivalent). You will need to declare this amount to any other aid awarding body who requests information from you on how much de minimis aid you have received.

Please advise us now of any other de minimis aid which your enterprise and any enterprises linked to it may have received during your current and previous two fiscal years, as we need to check that our support added to that previously received, will not exceed the threshold of €200,000) over the last three fiscal years. De minimis aid includes not only grant but also assistance such as free or subsidised consultancy services, marketing advice etc. If you are in any doubt about whether previous assistance received classes as de minimis assistance please include it.

Please sign the statement below confirming your eligibility for support.

Statement of de minimis aid receivedI confirm that I have received the following de minimis aid during the previous three fiscal years (i.e. current fiscal year and the previous two fiscal years):

Body providing the assistance/aid Value of assistance Date of assistance

Signed

Name

Organisation

Position

Date

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