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Application Form

1 - IDENTIFICATION

Bilateral Initiative Name *

Implementation Period From: *

Implementation Period To: *

Total Amount of the Bilateral Initiative *

Requested Amount *

Applicant Entity *

Tax ID Number *

Address *

Phone of the Entity *

E-mail of the Entity *

Name of legal representative *

Function in the Entity *

Bilateral Initiative Manager *

Function in the Entity *

Phone of the Manager *

E-mail of the Manager *

Consentment *

I AUTHORIZE the National Focal Point to collect and process the personal data refered in the application exclusively for this selection process.
I AUTHORIZE that the indicated e-mails is used as the address for receiving communications from the National Focal Point regarding the application selection procedure.
I AUTHORIZE that the indicated e-mails are part of the National Focal Point database for the purposes of dissimination of information on the EEA GRANTS.

2 - DESCRIPTION AND JUSTIFICATION

a) Outline a summary of the Bilateral initiative, identifying its objectives, the innovative approach proposed and the expected bilateral results *

b) Explain how the proposed results represent new solutions or new approaches, how can these results be relevant to the respective area of intervention and its potential for dissemination or scaling up of the proposed results *

c) Geographical impact *

d) Outline the planned activities to achieve the objectives referred to in a) above *

e) Describe the main achievements towards the two EEA Grants objectives *

f) Identify the target group or the final beneficiaries *

g) Outline the means and resources required to achieve the objectives set out in a) above *

h) Outline how the ongoing evaluation of the bilateral initiative will be ensured, identifying the associated risks and how they will be mitigated *

3 - PARTNERS INVOLVED

Entity

Country/City

Entity

Country/City

Entity

Country/City

Outline a summary of the role of the partners in the implementation of the bilateral initiative

6 - SUSTAINABILITY PLAN FOR THE ESTABLISHED BILATERAL RELATIONS

Describe the sustainability of the bilateral partnership and the possibility of future collaboration *

Did the partnership already exist? *

Yes
No

Please describe why or how you find the partner(s) for this application (v.g matchmaking event, etc.)

7 - REVENUES

The bilateral initiative will generate revenue? *

Yes
No

Identify the total amount of revenue preview during the period of execution of the initiative and justify:

8 - DOCUMENTS REQUIRED

Documents required *

Term of Responsability
Statutory documents of the applicant entity
Proof of the regularized situation with the Tax Authority
Proof of the regularized situation with the Social Security
Certificate proving the VAT regime
Letters of intent from Donor States Partners
Letters of intent from national partners and/or from other beneficiary states (if applicable)
Unique or autonomous undertaking declaration (if applicable)
Budget and timeline