GRANT AWARD PROCEDURE

APPLICATION FORM

for Joint Municipal Enterprise

(APPENDIX I)

1. Applicant (joint municipal enterprise[1])

Official name ►

Legal form ►

Registration number (if any) ►

Founding municipalities ►

Country of registration ►

Full address ►

Internet site (if any) ►

Date on which the applicant was founded ►

Objectives of the applicant

(as stipulated in its Statutes) ►

Name(s) of the person(s) entitled to enter into legally binding commitments on behalf of the applicant (indicate names and position) ►

Members of the governing board (or equivalent body, if applicable). Indicate names, positions and professions ►

2. Contact details

Contact person ►

Position of the contact person ►

Email address ►

Phone number ►

3. Bank details

Name of the Bank ►

Address of the Bank ►

Account holder name ►

Full account number

(including bank codes) ►

IBAN (or BIC Code) ►

4. Situation analysis (maximum 1 and ½ page)

a) Provide a synopsis of the applying joint municipal enterprise, as well as about founding municipalities: territory, population, services provided by the joint municipal enterprise, development trends and economy, etc. ▼

b) Describe the significance of the proposed project to all the municipalities covered by the joint municipal enterprise and how it will contribute to fostering inter-municipal partnerships and to improving the public services provided to citizens ▼

5. Recent activities (maximum ½ page)

Describe below the main projects completed or being carried out by the joint municipal enterprise or by any of the founding-municipalities during the last year, including in the in the field of inter-municipal cooperation (if any) ▼

6. Overall duration of the project (maximum ¼ page)

Please indicate the length of the proposed project and/or specific phases planned. Note that the implementation period of the projects to be financed by the Council of Europe should not extend beyond 31 October 2017; reporting requirements should be completed by 30 November 2017 ▼

7. Proposed activities (maximum 2 pages)

Please describe below the general objective of the proposed activities and (if any) the specific objectives.

For each activity, indicate the title, duration, detailed description, implementation means, evaluation means, and expected results. When preparing the proposal, please consider the following questions:

How will the activities undertaken lead to the achievement of the expected results?

What is the sequence of the activities?

Who will be responsible for carrying out each activity and what is their role in the project?

How will the community be involved in the project implementation?  

How will gender mainstreaming be included in the implementation of the project?

How will sustainability of the project be ensured following its completion▼

8. Applicant’s professional capacity (maximum ½ page)

Indicate below the number of permanent and temporary staff. Indicate any specific experience of the staff in implementing projects.  ▼

9. Applicant’s operational capacity (maximum ½ pages)

Please indicate whether the enterprise has its own office, equipment, accounting software  and other means necessary to ensure proper implementation of the project ▼

10. Applicant’s financial capacity (maximum ½ page)

Indicate below any information reflecting the applicant’s financial capacity, such as turnover or equivalent (annual budget) for the last year, net earnings (if any), total balance sheet or budget, or medium and long-term debt (if any) ▼

11. Co-funding (maximum ¼ page)

Indicate below how the applicant intends to contribute to the project (either by way of its own resources or by contribution from founding municipalities or third parties). Co-financing may take the form of financial or human resources, in-kind contributions or income generated by the action or project ▼

12. Declaration

By signing this form  I, the undersigned, authorized to represent the applicant, hereby certify that the information contained in this application is correct and that the applicant organisation has not received or applied for any other Council of Europe funding to carry out the action which is the subject of this grant application.

I also certify on my honour that the applicant organisation is not in one of the situations which would exclude it from taking part in a Council of Europe grant award procedure, and accordingly declare that the applicant:

a. has not been sentenced by final judgment on one or more of the following charges: participation in a criminal organisation, corruption, fraud, money laundering;

b. is not in a situation of bankruptcy, liquidation, termination of activity, insolvency or arrangement with creditors or any like situation arising from a procedure of the same kind, or is not subject to a procedure of the same kind;

c. has not received a judgment with res judicata force, finding an offence that affects its professional integrity or constitutes a serious professional misconduct;

d. does comply with its obligations as regards payment of social security contributions, taxes and dues, according to the statutory provisions of the country where it is established.

13. Signature

Complete the table below and sign in the last box

First Name and Name of the Signatory ►

Title or position of the Signatory in the applicant organisation ►

Place and date of signature ►

Done in:

On :

Signature and official stamp

of the applicant ►