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Contracting Authority_ European Union

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Contracting Authority_ European Union

    Contracting Authority: European Union

    Represented by the European Commission

    EU-CHINA Research and Innovation Partnership

    Grant Application Form

    Budget line: 19.100400

    Reference: EuropeAid/135-587/DD/ACT/Multi

    Deadline for submission of

    First step - Concept notes: 23 May 2014

    Second step applications: to be confirmed

    To reduce expense and waste, we strongly recommend that you use only paper for your file (no plastic

    folders or dividers). Please also use double-sided printing if possible

     Title of the action:

    Number and title of lot

    Location(s) of the

    benefit from the Action> action:

    Name of the applicant

     Nationality of the

    1applicant

    Dossier No

    (for official use only)

    2EuropeAid ID

    1 An organisation’s statutes must show that it was established under the national law of the country concerned and that the head office is located in an eligible country. Any organisation established in a different country cannot be considered an eligible local organisation. See the footnotes to the Guidelines for the call. 2 To be inserted if the organisation is registered in PADOR (Potential Applicant Data On-Line Registration). For more information and to register, please visit http://ec.europa.eu/europeaid/onlineservices/pador.

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Ongoing contract/Legal Entity 3File Number (if available)

    4Legal status

    Name; EuropeAid ID; Nationality and date of establishment; 5Co-applicant Legal status; Relation with the applicant or co-applicant

    Name; EuropeAid ID; Nationality and date of establishment; 6Affiliated entity Legal status; Relation with the applicant or co-applicant

Applicants contact details for the purpose of this action

     Postal address:

    Telephone number: (fixed and mobile) Country

    code + city code + number

     Fax number: Country code + city code + number

     Contact person for this action:

     Contact persons email:

     Address:

     Website of the Organisation:

Any change in the addresses, phone numbers, fax numbers or e-mail, must be notified in writing to

    the Contracting Authority. The Contracting Authority will not be held responsible in the event that

    it cannot contact an applicant.

3 If an applicant has already signed a contract with the European Commission and/or has been informed of the

    Legal Entity File number. If not, write N/A.

    4 E.g. non-profit, governmental body, international organisation. 5 Use one row for each co-applicant.

    6 Use one row for each affiliated entity..

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    NOTICE

    [How to adapt this standard grant application form:

    Where you see < ... >, enter the information relevant to the call for proposal in question.

    The phrases within [ ] should only be included if appropriate, while the paragraphs shaded in grey should only need to be amended in exceptional cases, dictated by the requirements of a particular call for proposal procedure.

    In no circumstances may you alter any other part of these standard instructions. Please remember to

    delete this paragraph, any other text with yellow highlighting and all such brackets in the final version]

    When processing your application, any personal data (e.g. names, addresses and CVs), will be recorded and processed if necessary in accordance with Regulation (EC) No 45/2001 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. Unless otherwise specified, your replies to the questions and any personal data are required only to evaluate your proposal in accordance with the Guidelines for the call for proposal and will be processed solely for that purpose by the data controller. Details concerning processing of your personal data are available in the privacy statement at

http://aideprgp.cc.cec.eu.int:1261/europeaid/prag/annexes.do?group=A&locale=en

    The Data Controller of this call for proposals is the Head of Europeaid legal affairs unit.

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    Contents

    PART A. CONCEPT NOTE ............................................................................................. 5 1 Instructions for drafting the concept note ......................................................................... 5

    Summary of the action ...................................................................................................................... 5

    Description of the action (max 1 page) .............................................................................................. 6

    Relevance of the action (max 3 pages) .............................................................................................. 6 2 Checklist for the concept note ............................................................................................ 8 3 Declaration by the applicant for THE concept note ........................................................ 10 4 Assessment grid for THE concept note ............................................................................ 11 PART B. FULL APPLICATION FORM ......................................................................... 12 1 General information ......................................................................................................... 12 2 The action .......................................................................................................................... 13

    Description of the Action .................................................................................................................13

    2.2. Affiliated entity(ies) experience (if applicable) .......................................................................18 3 The applicant .................................................................................................................... 20

    3.1. Identity ...................................................................................................................................20

    3.2. Profile .....................................................................................................................................21

    3.3. Capacity to manage and implement actions..............................................................................28

    3.4. List of the management board/committee of your organisation ................................................31 4 The Co-applicant(s) .......................................................................................................... 32

    Important: This application form must be accompanied by a signed and dated Mandate from each

    co-applicant, in accordance with the template provided............................................................33

    Mandate (for co-applicant(s))........................................................................................................33 5 AFFILIATED ENTITIEY(ies) participating in the action ............................................. 34

    Description of the affiliated entity(ies) .............................................................................................34

    Affiliated entity(ies)'s Statement ......................................................................................................36 6 Associates of the applicant participating in the action .................................................... 37 7 Checklist for the full application form ............................................................................. 38 8 Declaration by the applicant ............................................................................................ 40 9 Assessment grid FOR the full application form .............................................................. 42

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    PART A. CONCEPT NOTE

    1 INSTRUCTIONS FOR DRAFTING THE CONCEPT NOTE

    Please note that if this is a restricted call, only the concept note should be submitted in the first stage (no full application). If this is an open call, both the concept note and the full application should be submitted at the same time.

    There is no specific template for the Concept Note but the applicant must ensure that the text: does not exceed 5 full pages (A4 size) of Arial 10 characters with 2 cm margins, single line spacing; provides the information requested under the headings below, in the order in which it is requested,

    and in proportion to its relative importance (see the relevant scores set out in the evaluation grid

    and in the Guidelines);

     provides full information (as the evaluation grid will be applied solely on the information in the

    concept note);

     is drafted as clearly as possible to enable it to be evaluated.

    7Summary of the action

    Please complete the table below, which should not exceed 1 page.

    Title of the action:

    [Lot: Lot X

    - Please tick the box corresponding to

     Lot Y] the specific lot for which you are

    applying:

    Location(s) of the action: specify

    country(ies), region(s) that will benefit

    from the action

    Total duration of the action (months):

    <EUR / currency of the Contracting Authority > EU financing requested (amount)

EU financing requested as a percentage % of total budget of the Action

    (indicative)

    Objectives of the action <Overall objective(s)>

    <Specific objective(s)>

    8Target group(s)

    9Final beneficiaries

     7 Cover page as per template in page 1 should be attached as well

    8 ―Target groups‖ are the groups/entities who will be directly benefit from the action at the action purpose level.

    9 “Final beneficiaries” are those who will benefit from the action in the long term at the level of the society or

    sector at large.

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Estimated results

    Main activities

    Description of the action (max 1 page)

    Please provide all the following information:

    Give the background to the preparation of the action.

    Explain the objectives of the action given in the table in Section 1.1.

    Describe the key stakeholder groups, their attitudes towards the action and any consultations held with them.

    Briefly state the type of activities proposed and specify related outputs and results, including a description of linkages/relationships between activity clusters.

    State the broad timeframe for the action and describe any specific factor that has been taken into account. Relevance of the action (max 3 pages)

    1.1.1. Relevance to the objectives/sectors/themes/specific priorities of the call for proposals Please provide all the following information:

    Describe the relevance of the action to the objective(s) and priority (ies) of the call for proposals. Describe the relevance of the action to any specific subthemes/sectors/areas and any other specific requirements stated in the Guidelines for the call, e.g.,local ownership etc.

    Describe which particular expected results referred to in the Guidelines for the call will be addressed.

    10[NB: In exceptional cases where it is impossible to involve national organisations from the target

    country because of the particular situation in that country, the applicant must provide explanations, which will be examined when applying criterion 1.1 of the evaluation grid to the Concept Note.]

    1.1.2. Relevance to the particular needs and constraints of the target country/countries,

    region(s) and/or relevant sectors (including synergy with other EU initiatives and

    avoidance of duplication)

    Please provide all the following information:

    State clearly the specific pre-project situation in the target country/countries, region(s) and/or sectors (include quantified data analysis where possible).

    Provide a detailed analysis of the problems to be addressed by the action and how they are interrelated at all levels.

    Refer to any significant plans undertaken at national, regional and/or local level relevant to the action and describe how the action will relate to such plans.

    Where the action is the continuation of a previous action, clearly indicate how it is intended to build on the activities/results of this previous action; refer to the main conclusions and recommendations of any evaluations carried out.

    Where the action is part of a larger programme, clearly explain how it fits or is coordinated with that programme or any other planned project. Specify the potential synergies with other initiatives, in particular by the European Commission.

    1.1.3. Describe and define the target groups and final beneficiaries, their needs and

    constraints, and state how the action will address these needs

    Please provide all the following information:

10 See footnote 1.

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    Give a description of each of the target groups and final beneficiaries (quantified where possible), including selection criteria.

    Identify the needs and constraints of each of the target groups and final beneficiaries. Demonstrate the relevance of the proposal to the needs and constraints of the target groups and final beneficiaries.

    Explain any participatory process ensuring participation by the target groups and final beneficiaries. 1.1.4. Particular added-value elements

    Indicate any specific added-value elements, e.g. the promotion or consolidation of public-private partnerships, innovation and best practice, or other cross-cutting issues such as environmental issues, promotion of gender equality and equal opportunities, the needs of disabled people, the rights of minorities and the rights of indigenous peoples.

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    2 CHECKLIST FOR THE CONCEPT NOTE

    

    ADMINISTRATIVE DATA To be filled in by the applicant Name of the Applicant

    EuropeAid ID number

    11Nationality/Country and date of 12registration

    13Legal Entity File number

    14Legal status

    15Co-applicant

    Name of the co-applicant

    EuropeAid ID number

    Nationality/Country and date of

    registration

    Legal Entity File number

    Legal status

    16Affiliated Entity

    Name of the Affiliated-Entity

    EuropeAid ID number

    Nationality/Country and date of

    registration

    Legal status:

    Specify to which entity you are affiliated

    (applicant and/or the co-applicant).

    Specify the kind of affiliation you have with that entity.

11 For individuals.

    12 For organisations.

    13 If the applicant has already signed a contract with the European Commission.

    14 E.g. non-profit, governmental body, or international organisation.

    15 Add as many rows as co-applicant(s) 16 Add as many rows as affiliated entities 2013.1.rev Page 8 of 43 Page 8 of 43

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    Tick the items off

    below BEFORE SENDING YOUR CONCEPT NOTE, PLEASE CHECK THAT EACH OF THE CRITERIA BELOW HAVE BEEN MET IN FULL AND TICK THEM OFF

    Title of the Proposal: Yes No PART 1 (ADMINISTRATIVE) 1. The Instructions for the Concept Note have been followed.

    2. The Declaration by the Applicant has been filled in and signed. 3. The proposal is typed and is in English. 4. One original and 5 copies are included. 5. An electronic version of the concept note (CD-Rom) is enclosed. PART 2 (ELIGIBILITY) 6. The action will be implemented in an eligible country(ies) or in the minimum required number of eligible

    countries.

    7. The duration of the action is between 36 months and 48 months (the minimum and maximum allowed).

     8. The requested contribution is between the minimum and maximum allowed

     600,000 800,000 EUR

     9. This Checklist and the Declaration by the Applicant have been filled in and sent with the Concept Note. 2013.1.rev Page 9 of 43

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3 DECLARATION BY THE APPLICANT FOR THE

    CONCEPT NOTE

    The applicant, represented by the undersigned, being the authorised signatory of the applicant, and in the context of the present application, representing any co-applicant(s), affiliated entity(ies) in the proposed action, hereby declares that:

    ; the applicant has the sources of financing and professional competence and

    qualifications specified in Section 2 of the Guidelines for Applicants;

    ; the applicant undertakes to comply with the obligations foreseen in the affiliated

    entities' statement of the grant application form and with the principles of good partnership

    practice;

    ; the applicant is directly responsible for the preparation, management and

    implementation of the action with the co-applicant(s) and affiliated entity(ies), if any, and is

    not acting as an intermediary;

    ; the applicant, the co-applicant(s) and the affiliated entity(ies) are not in any of the

    situations excluding them from participating in contracts which are listed in Section 2.3.3 of

    the Practical Guide to contract procedures for EU external actions (available from the

    following Internet address:

    http://ec.europa.eu/europeaid/work/procedures/implementation/index_en.htm. Furthermore, it

    is recognised and accepted that if we participate in spite of being in any of these situations, we

    may be excluded from other procedures in accordance with Section 2.3.4 of the Practical

    Guide;

    ; the applicant and each co-applicant(s) and affiliated entity(ies) (if any) are in a

    position to deliver immediately, upon request, the supporting documents stipulated under

    Section 2.4 of the Guidelines for Applicants.;

    ; the applicant and each co-applicant(s) and affiliated entity(ies) (if any) are eligible in

    accordance with the criteria set out under Sections 2.1.1 and 2.1.2 of the Guidelines for

    Applicants;

    ; if recommended to be awarded a grant, the applicants accepts the contractual

    conditions as laid down in the Standard Contract annexed to the Guidelines for Applicants

    (annex G);

    ; the applicant, the co-applicant(s) and the affiliated entity(ies) are aware that, for the

    purposes of safeguarding the financial interests of the European Union, their personal data

    may be transferred to internal audit services, to the European Court of Auditors, to the

    Financial Irregularities Panel or to the European Anti-Fraud Office.

    Signed on behalf of the applicant

Name

    Signature

    Position

    Date

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