Aanvraagformulier



Application form for a grant for a project

|Project title (preferably not | |

|more than 50 characters | |

|Type (select) | |Development |

| | |Research |

|Start date | |

|End date | |

|Duration (months) | |

|Location where project will be | |

|executed | |

|Budget requested (Euro) | |

|Total budget (Euro) | |

|Summary (approx. 10 lines) | |

| | |

| | |

| | |

| | |

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Applicant details:

Project leader:

|Title | |

|Surname | |

|First name(s) | |

|Postal address | |

|Physical address | |

|Phone/Cell number | |

|E-mail address | |

Participants:

(this table is to be copied and pasted below, and filled out by each applicant

|Participant 1 |

|Title | |

|Surname | |

|First name(s) | |

|Phone/Cell number | |

|E-mail address | |

|Participant 2 |

|Title | |

|Surname | |

|First name(s) | |

|Phone/Cell number | |

|E-mail address | |

Contact person:

|Title | |

|Surname | |

|First name | |

|Postal address | |

|Physical address | |

|Phone/Cell number | |

|E-mail address | |

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Financial details:

Please note: Mention in your proposal the costs of the project without VAT and always include the VAT separately.

1. Registration number (if applicable)

|NL |Inschrijfnummer handelsregister KvK | |

|VL |BTW-nummer / Ondernemingsnummer | |

|SA |VAT number / unique identifier of company | |

2. Banking details:

|Name | |

|Bank | |

|Account number | |

|Account name (name of account holder) | |

|Branch name | |

|Branch code | |

|IBAN | |

|SWIFT / BIC code | |

3. Financing

|Has a proposal for financing (parts of) this project (including loans) already been submitted to or granted by other funding organisations|

|(Flemish, Dutch, South-African or European)? |

|If yes: | |Yes |

| | |No |

|Funding organisation(s) | |

|Specific funding scheme / | |

|instrument | |

|Amount requested | |

|Amount granted | |

|E-mail address | |

4. Project costs

(to be filled for the entire consortium as well as for each individual participant, add copies of this form)

Costs presented in this proposal can be spent on the activities described in the proposal, and cannot include activities before the start or after the end of the project. A detailed description and justification of the costs presented (e.g., monthly salary per category) must be available in a transparent manner.

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Annexes:

Annex 1: Project plan (maximum six A4 page)

The project plan (of the entire project) should provide detail on the following (see also the call text):

• Project team members and contact persons; their expertise, input, hourly rate, share in the work and responsibilities and roles in the proposed work plan with a clear distribution of the project costs and budget amongst the project team members;

• aim of the project, including target group (size ?) and potential follow-up activities;

• expected material (e.g., teaching material, software) or immaterial (e.g., skills) results of the project; how can one measure the success of the project;

• a realistic plan for maintenance of the project results after the end of the project (sustainability) and knowledge/technology transfer including the role of each team or consortium member;

• a description of the method and materials, including a timeline with clearly distinguishable parts and phases linked to (partial) results and identifiable costs;

• the way how SMART indicators will be used to measure the success of (parts of) this project;

• a description of the added value of this project for HLT;

• a budget specifically per work package and cost type (cf. section B of this form);

• a summary for laymen.

Annex II: Consortium/Project agreement

An agreement detailing the nature of the collaboration should be included. A consortium agreement is optional. In cases of more informal collaboration (without a consortium agreement being submitted), minimally the authorisation of the project team members that allows the project coordinator/ main applicant to submit the proposal in their name must be provided in a signed accompanying letter of approval.

The following topics should nevertheless be (shortly) addressed and incorporated in the signed letters of approval from all project team members:

• the purpose and goals of the co-operation;

• the way of co-operating, including a set of warranties and disclaimers allocating risk between the parties;

• the arrangement of the (intellectual) property regarding the project, the project results and its utilisation or exploitation by third parties (with specific reference to distribution via the HLT Agency in the Dutch area and/or the Resource Management Agency in South Africa).

← In particular, this latter item is important for one of the evaluation criteria.

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Completeness check

|Is the project plan numbered by page, scanned and included? | |Yes |Number of pages: | |

| | |No | | |

|Is the consortium agreement annex numbered by page, scanned and | |Yes |Number of pages: | |

|included? | | | | |

| | |No | | |

|Is the form duly and completely filled out? | |Yes | |

| | |No | |

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Signature

Signing party declares that all needed information and annexes are included and that s/he has full knowledge and understanding of the terms and obligations as described in the call for proposals text.

Duly and truly completed by

Name :     

Function :     

Place :     

Date :     

Signature …………………………………

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Submit this form to: Ms Ulrike Janke: ulrike.janke@.za

The application is submitted by a main applicant for the project team. The project team members provide their details to the main applicant who submits on their behalf. The approvals of the other project team members that the main applicant may submit on their behalf must be included in the project agreement (may consist of scanned letters of approval).

The project team undertakes to indicate clearly in all published material (flyers, web sites, presentations, etc.…) that the Nederlandse Taalunie and Department of Arts and Culture of the Government of South Africa have contributed financially towards the activity under their joint Programme of Collaboration. The following example sentence may be used for this purpose:

This project is carried out within the joint Programme of Collaboration on HLT which is funded by the Nederlandse Taalunie and Department of Arts and Culture of the Government of South Africa ( or ).

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