EUROPEAN COMMISSION EUROPEAN ANTI-FRAUD OFFICE (OLAF) BUDGET Unit D6 GRANT PROGRAMME 2011 TECHNICAL ASSISTANCE FOR LAW ENFORCEMENT AGENCIES FOR THE PREVENTION, DETECTION AND INVESTIGATION OF CIGARETTE SMUGGLING EUROPEAN ANTI-FRAUD OFFICE (OLAF) GRANT APPLICATION FORM Applicant Organisation: Title of the Action: Applicant Country: Date of submission: closing date: Closing date: 25 November 2011
Notes: Before completing this Form, please read carefully the Call for Proposals, and all other relevant documents concerning the Technical Assistance Programme available on OLAF s website at the following address: http://ec.europa.eu/anti_fraud/programmes/index_en.html. All fields of this form must be completed with either a relevant answer, None or Not applicable. Incomplete forms will not be accepted. 1. DETAILS OF THE APPLICANT Identity of Applicant Full legal name of the Organisation: Abbreviated name or acronym (where applicable): Unit / Division name (where applicable): Legal status of applicant: Official Registration No (where applicable): VAT Registration No (where applicable): Sector: Private Public (Law Enforcement Administration) Address of registered office Street / No: Postcode: City / Country: Internet site: Person authorised to sign a Grant Agreement on behalf of the Applicant Organisation Name: Title (e.g. Mr, Mrs, Ms, ): Position: Telephone No: Fax No: E-mail address: Version 1.1-EN September 2011 page 2 of 16
Contact person (if different from the above) Name: Title (e.g. Mr, Mrs, Ms, ): Position: Address: Postcode: City / Country: Telephone No: Fax No: E-mail address: Particulars of Applicant s bank Bank Name: Street / No: Postcode: City / Country: Bank Account No: IBAN: BIC code (SWIFT): Name of principal account holder: Title or position in the Organisation: Note: The bank account or sub-account to be used in respect of this application must enable the funds transferred by the Commission to be identified. This bank account must be registered in the Commission payment system. To this end, OLAF will provide a financial identification form to be filled, signed and stamped by the bank, after the awarding of the Grant. Version 1.1-EN September 2011 page 3 of 16
Brief description of the Applicant s activities and general aims (max. 10 lines): - Applicant s date of establishment: - Applicant s statutory objectives: - Current principal activities of the Applicant: - Principal realised/ongoing actions in the area of the present application: EU grants, procurement contracts or loans obtained directly or indirectly during the last three years from a European Institution or Agency. Please specify: Year of the award EU Institution / Programme Title of the action & Contract No Duration Amount of the grant, contract or loan Grant applications submitted (or due to be submitted) to European institutions in the current year Year of submission EU Institution / Programme Title of the action Estimated duration Estimated amount of the grant Note: Applicants shall immediately inform OLAF of any request for funding submitted to, or Version 1.1-EN September 2011 page 4 of 16
approved by other Commission departments or EU Institutions AFTER this application. Version 1.1-EN September 2011 page 5 of 16
2. DETAILS OF THE ACTION FOR WHICH A GRANT IS REQUESTED Brief description of the action for which the grant is sought (min. 400 / max. 1.000 words): Note: Where applicable, Applicants should indicate work connected with the action that they plan to subcontract to an outside organisation / company / association Expected results of the action for which the grant is sought (min. 400 / max. 1.000 words): Summary timetable for the action Estimated Start Date: Notes: Please allow sufficient time for the administrative formalities after the closing date, before the commencements of the action. The timetable for performance of the action set the limits of the eligibility period of the expenditure. Applicants are not be permitted to include in their budgets expenditure incurred prior to or after the period specified in the grant agreement, in accordance with the Financial Regulation of 23 December 2002 applicable to the general budget of the European Union as amended. A grant may be awarded for an action that has already begun only where the applicant can demonstrate the need to start the action before the agreement is signed. In such cases, expenditure eligible for financing may not have been incurred prior to the date of submission of the grant application. Applicants are invited to provide the required justification, when applicable. Total cost of the action (in Euro): Amount of the grant requested to OLAF (in Euro): Version 1.1-EN September 2011 page 6 of 16
3. ESTIMATED BUDGET FOR THE ACTION Notes: The Applicant certifies that the costs indicated below are necessary to implement the action for which a Grant is requested and generated during its lifetime. The different types of expenses shown here are indicative only and can vary depending on the action. However, the provisional budget must be as clear and detailed as possible. The estimated budget shall give a detailed breakdown of the costs that the action may entail and of all receipts, so that receipts and costs balance. Costs should not include VAT, unless the beneficiary can show that he is unable to recover them. PART A - Total estimated expenditure and eligible costs (Amounts in Euro) Direct Expenditure OLAF Contribution Technical equipment, land and immovable property - Note 1 (a) (b) Consumables and supplies - Note 2 (c) (d) Staff assigned to the action - Note 3 (e) (f) Total Direct Expenditure (a + c + e) or (b + d + f) (k) (l) TOTAL ELIGIBLE COST (k or l) (q) (r) Applicant contribution TOTAL BUDGET (q+r) (s) PART B - Financing Plan Contribution sought from OLAF (max 50% of total eligible cost) Note 6 Contributions from other sources than OLAF Contribution by the applicant Contributions by other organisations (please specify) Direct revenue expected from the action Amounts in Euro (q) (r) Estimated bank interest generated by the grant requested 1 Contributions by the Commission for the same action (where applicable) TOTAL FINANCING (s) 1 Interest generated on pre-financing below 50.000 can be kept by beneficiary; Interest on pre-financing between 50.000 and 75.000 will be deducted directly from payment; recovery order only for interest on pre-financing above 75.000. Version 1.1-EN September 2011 page 7 of 16
PART C - Detailed Expenditure 1 (amounts in Euro) Technical equipment, land and immovable property (purchase, rent) Description Quantity Unit cost Total cost Total (a) Version 1.1-EN September 2011 page 8 of 16
PART C - Detailed Expenditure 2 (amounts in Euro) OLAF Contribution Consumables and supplies Quantity Unit cost Total cost Total (c) Staff assigned to the action Quantity Unit cost Total cost Total (e) Travel and subsistence expenses Quantity Unit cost Total cost Total (g) Any other direct costs including banking charges Quantity Unit cost Total cost Total (i) Applicant Contribution Consumables and supplies Quantity Unit cost Total cost Total (d) Staff assigned to the action Quantity Unit cost Total cost Total (f) Travel and subsistence expenses Quantity Unit cost Total cost Total (h) Any other direct costs Quantity Unit cost Total cost Version 1.1-EN September 2011 page 9 of 16
Total (j) Version 1.1-EN September 2011 page 10 of 16
Note: the detailed expenditure tables above can be edited by adding / removing lines as required for each cost category (equipment, consumables, staff cost, travel & subsistence and other direct costs). The Grant Application Form can be downloaded from OLAF web site at the following address: http://ec.europa.eu/anti_fraud/programmes/index_en.html. Note 1: the purchase cost of equipment can be eligible provided that it is written off in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the same kind. Pro-forma invoices will have to be supplied for equipment for which OLAF funding is requested Note 2: the costs of consumables and supplies can be eligible provided that they are identifiable and assigned to the action. Note 3: staff costs can only be charged for training actions. Applicants must explain the functions and tasks of each person, together with an estimate of the number of days/months they will dedicate to the action. They must also specify whether the personnel are made available by their Organisation or whether they are external staff necessary for the effective implementation of the action (e.g. interpreters). The eligible cost of staff assigned to training actions comprise actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average rates corresponding to the beneficiary s usual policy on remuneration. Statutory staff belonging to public bodies assigned to technical assistance actions should be financed by the Applicant Organisation or by other sources of financing. Note 4: the travel and subsistence costs of the participants in the action must be consistent with the beneficiary s normal practices in these matters and not exceed the rates approved annually by the Commission. Note 5: other direct costs entailed by contracts awarded by the beneficiary for the purposes of carrying out the action (i.e. training) or arising directly from requirements imposed by the Commission (i.e. audits, reproduction, specific evaluation of the action, etc.), including the costs of any financial services (especially the cost of financial guarantees) can be eligible. Note 6: OLAF's financial contribution shall not exceed 50% of the total eligible expenditure of the project, except in the case of the organisation of seminars or training actions, where it may not exceed 80% of the total eligible expenditure. General note on purchases and subcontracting: Subcontracting for the implementation of the action must be justified; Acquisitions and subcontracting must both be awarded according to national procurement rules, respecting the principles of transparency, equal treatment of potential suppliers and contractors, and ensuring absence of conflicts of interest. Version 1.1-EN September 2011 page 11 of 16
4. DECLARATION BY THE APPLICANT ORGANISATION The signatory to this Form., legally authorised to represent the Applicant, applies for a Grant of an amount of EUR with a view to the implementation of the Action within the conditions described in the present application. I declare that the information included in the present application is accurate and that the Applicant Organisation has neither received other EU funding nor introduced another application for EU funding in view of the implementation of the action, subject of the present grant application. Exclusion criteria I declare on my honour that the Organisation submitting this Grant application is not in one of the cases for exclusion from the EU Grant Programme and I declare for this purpose that the abovementioned Organisation: a) is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors, has not suspended business activities, is not the subject of proceedings concerning those matters, and is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations; b) has not been convicted of an offence concerning professional conduct by a judgement which has the force of res judicata; c) has not been guilty of grave professional misconduct proven by any means which the contracting authority can justify; d) has fulfilled its obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the country in which it is established; e) has not been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal Organisation or any other illegal activity detrimental to the EU's financial interests; f) has not been declared, following another procurement procedure or grant award procedure financed by the EU budget, to be in serious breach of contract for failure to comply with its contractual obligations; g) is not subject to a conflict of interest; h) has not committed misrepresentation in supplying the information required by OLAF as a condition of participation in the contract procedure or failed to supply this information. Version 1.1-EN September 2011 page 12 of 16
Penalties I confirm that I have been notified about the fact that according to the Financial Regulation of 23 December 2002 applicable to the general budget of the EU, administrative or financial penalties may be imposed on Applicants who are excluded on the basis of the above criteria or who make false declarations in providing the information required in connection with their participation in this call for proposals. The administrative penalties consist of an exclusion from all contracts and grants financed by the EU budget for a maximum duration of two years from the time when the infringement is established, as confirmed after an adversarial procedure. This period may be extended to three years in the event of a repeat offence within five years of the first infringement. Applicants who have been guilty of making false declarations shall also receive financial penalties representing 2% to 10% of the total value of the grant in question. That rate may be increased to 4% to 20% in the event of repeat offence within five years of the first infringement. Official Journal of the European Union L 357/37dated 31 December 2002. Complaints to the European Ombudsman At all stages of the administrative handling of grant files, whenever persons or bodies involved consider that they are the victim of maladministration, they may, independently of any other avenue of appeal, make a complaint before the European Ombudsman in accordance with Article 195 1 of the EC Treaty and under the conditions contained in the European Parliament decision dated 9 March 1994 with regard to the statute and the general conditions governing the exercising of the functions of the Ombudsman, published in the Official Journal of the European Union L 113 dated 4 May 1994. Protection of Personal Data Your application will be handled electronically. Data of a personal character (for example, name or address of natural persons) will be handled in conformity with the provisions of Regulation (EC) No 45/2001 of the European Parliament and the Council dated 18 December 2000 (OJ L8 of 12/01/2001) on the protection of individuals with regard to the processing of personal data by the EU institutions and bodies and on the free movement of such data. The answers to the questions within the present form are necessary in order to evaluate your grant application and they will be dealt with exclusively for this purpose by the department in charge of the grant programme in question. You may, on request, have the personal data communicated to you, correct it or complete it. For all questions related to this data, you may contact the department of the Commission to which this form is sent. Concerning the treatment of your personal data, you may make a complaint before the European Data Protection Supervisor at any stage. Version 1.1-EN September 2011 page 13 of 16
5. DECLARATION BY THE PERSON AUTHORISED TO SIGN A GRANT AGREEMENT I, the undersigned, responsible within the Applicant Organisation for the action being co-financed, hereby certify that the information given in this application is true and complete. Name: Position in the Applicant Organisation: Place: Date: Signature: Official stamp (if applicable): Grant Application Form (original and copy) to be sent to the following mail address: European Commission European Anti-Fraud Office (OLAF) For the attention of Mr. Jean-Philippe LIENARD B-1049 Brussels Belgium The envelope should prominently display the words: Application for OLAF Technical Assistance Grant Programme Cigarettes 2011. A copy of the dossier may also be sent by electronic mail to the following mailbox: OLAF-FMB-HER-II-CIGARETTES-D6@ec.europa.eu Version 1.1-EN September 2011 page 14 of 16
6. SUPPORTING DOCUMENTS TO BE INCLUDED WITH THE GRANT APPLICATION Documents to be included with all grant applications Note: Failure to include these may result in your application being rejected (1) Description of the action (2) A detailed technical description of the X-ray scanning system and the cost of the equipment for which a grant is requested. (3) A detailed statement explaining the need for the X-ray scanning system for which a grant is requested, including an inventory of scanning systems currently deployed by the national law enforcement agency requesting a grant, (4) A declaration by which the grant applicant agrees to provide the awarding authority with a report 12 months after the date on which the grant was awarded and 24 months after the date on which the grant was awarded, stating when the X-ray scanning system became operational, how many controls have been performed during the reporting period using the equipment and how many seizures have been made during the reporting period as a result of using the equipment. (5) Where applicable, a sworn statement in which the applicant certifies that he is in none of the situations described at point 3.2 (exclusion criteria) as stated in Section 4 of the Grant Application Form. (6) Pro-forma invoices for equipment for which OLAF funding is requested or an official price list of the supplier of the equipment for which a grant is requested Note: estimates relating to the declared expenses in the draft budget may be requested at a later date, after the awarding of a Grant. Documents to be included when the beneficiary is not a law enforcement body Version 1.1-EN September 2011 page 15 of 16
(1) Official registration certificate (2) Statutes of the Applicant / Articles of association (3) List of directors / executive board members (names and positions in the Applicant Organisation) (4) Applicant s annual accounts for the last financial year (or annual budget in the case of a public body) (5) Auditor s report issued within the last two years by an approved auditing firm (6) Financial guarantee for the payment of pre-financing (50% of the amount requested) by an approved bank of financial institution established in one of the Member States (see note below) (7) Particulars of: (a) (b) (c) current or earlier participation in actions financed by the European Commission contracts concluded with departments of the European Commission other particulars (e.g. actions on behalf of other international organisations or Member States of the European Union) (8) Undertaking by each co-financing organisation to provide the amount of funding indicated in the grant application (when applicable) (9) Curriculum vitae of persons to be performing work in connection with the action Note: The financial guarantee may be provided at a later date after the awarding of a Grant. Version 1.1-EN September 2011 page 16 of 16