Application Form Part A - European Commission
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|Connecting Europe Facility 2014-2020 |
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|2019 ENERGY Call for proposalS |
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|APPLICATION FORM |
|PART A |
|General information |
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|Title of the proposed Action | |
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|TENtec number | |
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A1 |
| | |ENERGY | |
|TENtec proposal number | |
|General Information on the Proposed Action |
|Call for proposals |CEF-Energy-2019 ▼ |
|Call priority |Not applicable ▼ |
|Call sub-priority |Not applicable |
|Title of the proposed Action | |
|Proposal type |▼ |
|Start date of the proposed Action | |End date of the proposed Action | |
|Scope and objectives of the proposed Action (up to 2000 characters) |
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|Information on the Project of Common Interest |
|Project of Common Interest 1 |
|Commission Delegated Regulation (EU) 2018/540 Project of Common Interest number: |▼ |
|Title of the PCI | |
|Energy Sector | |
|Priority Corridor | |
|PCI Description | |
|Location | |
|Regions | |
|Project of Common Interest 2 |
|Commission Delegated Regulation (EU) 2018/540 |▼ |
|Project of Common Interest number: | |
|Title of the PCI | |
|Energy Sector | |
|Priority Corridor | |
|PCI Description | |
|Location | |
|Regions | |
….
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A2 |
| | |ENERGY | |
|TENtec proposal number | |
|List of Applicants |
|Applicant number |Applicant legal name |Legal status |Country |
|1 | | | |
|2 | | | |
|… | | | |
The coordinating applicant leads and represents all of the applicants in the proposal and acts as the point of contact with INEA during the application phase. Designating a coordinating applicant is an option, but not an obligation.
|Coordinating Applicant |
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|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A2.1 |
| | |ENERGY | |
|TENtec proposal number | |Applicant number | |
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|Applicant |
|Applicant legal name | |
|Legal address |
|Street | |
|City | |
|Postal Code | |
|Country | |
|VAT Number | |
|PIC Number | |
|Legal Status of the Applicant |
|Applicant legal status |▼ |
|1. EU Member State | |
|2. Third country | |
|3. Public sector undertaking or body established in the EU | |
|4. Private sector undertaking or body established in the EU | |
|5. Public sector undertaking or body established outside the EU | |
|6. Private sector undertaking or body established outside the EU | |
|7. International organisation | |
|8. Joint Undertaking established in the EU | |
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Does the applicant have the legal personality in accordance with the applicable national legislation?
YES
NO
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A2.2 |
| | |ENERGY | |
|TENtec proposal number | |Applicant number | |
|Applicant's legal name | |
|Contact Points |
|Person in charge (first point of contact for the EU, if necessary) |
|Gender | |Title | |
|Last name | |First name(s) | |
|Function | |
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|Is the address different from the legal address? |YES | |NO | |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|Phone | |
|Email | |
|Confirm email | |
|Representative authorised to sign this application |
|Gender | |Title | |
|Last name | |First name(s) | |
|Function | |
|Is the address different from the legal address? |YES | |NO | |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|Phone | |
|Email | |
|Additional representative authorised to sign this application |
|Gender | |Title | |
|Last name | |First name(s) | |
|Function | |
|Is the address different from the legal address? |YES | |NO | |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|Phone | |
|Email | |
|Date | |
|Signature | |
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A2.3 |
| | |ENERGY | |
|TENtec proposal number | |Applicant number | |
|Applicant's legal name | |
|Implementing Bodies |
|Implementing body's legal name | |
|Legal status |▼ |
|Legal address |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|EU Member State Approval |
|EU Member State Ministry's legal name | |
|Legal address |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|Representative authorised to sign this proposal |
|Gender | |Title | |
|Family name(s) | |First name(s) | |
|Function | |
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|Is the address different from the legal address? |YES | |NO | |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|Phone | |
|E-mail | |
|Date | |
|Signature of the competent EU Member State| |
|Ministry | |
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A2.4 |
| | |ENERGY | |
|TENtec proposal number | |Applicant number | |
|Applicant's legal name | |
|Affiliated Entities |
|Affiliated entity's name | |
|Legal status |▼ |
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|Legal address |
|Street name | |Number | |
|City | |
|Postal code | |
|Country | |
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A3.1 |
| | |ENERGY | |
|TENtec proposal number | |
|Location of the Action |
|Member State(s) | ▼ | ▼ | ▼ | ▼ | ▼ |
|Region(s) | ▼ | ▼ | ▼ | ▼ | ▼ |
|Third country(ies) | ▼ | ▼ | ▼ | ▼ | ▼ |
NUTS 2 nomenclature will be used for the regions.
|Activities of the Action |
|Activity number |1, 2, 3… |
|Activity name | |
|Implementing applicant(s) | |
|Activity description | |
|Indicative start date | |
|Indicative end date | |
|Verifying milestone(s) | |
|Milestones of the Action |
|Milestone number|Milestone description |Milestone summary |Indicative completion|Means of verification |
| | | |date | |
|2 | | | | |
|3 | | | | |
|… | | | | |
|Application Form Part A |
|[pic] |EUROPEAN COMMISSION |CONNECTING EUROPE FACILITY |A3.2 |
| | |ENERGY | |
|TENtec proposal number | |
|Financial information on the Action |
|Sources of Financing |
|Financing sources |Amount of financial contribution |Amount of financial contribution |Amount of financial |
| |to the action eligible costs |to the action eligible costs |contribution to the action |
| |(EUR) |(EUR) |eligible costs (EUR) |
| |[Applicant 1] |[Applicant N] |[Total] |
|1. CEF Energy financing |[…] |[…] |[…] |
|2. Applicant's own resources |[…] |[…] |[…] |
|3. CBCA contribution |[…] |[…] |[…] |
|3. EIB loan |[…] |[…] |[…] |
|4. Other loans |[…] |[…] |[…] |
|5. State budget(s) |[…] |[…] |[…] |
|6. Regional/local budget(s) |[…] |[…] |[…] |
|7. Income generated by the proposed Action |[…] |[…] |[…] |
|8. Other sources |[…] |[…] |[…] |
|Total |[…] |[…] |[…] |
|Indicative breakdown of estimated eligible costs by activity |
|Co-financing rate | |
|Activities |
If the proposed Action is part of a PCI previously supported through EU funding, please specify all related Actions:
|Action title |Funding programme |Grant Agreement/Decision number |Awarded amount |
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|Exchange Rate |
|If applicable, please indicate the exchange rate used for preparing the application: | |
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