REINVESTMENT PROJECT FORM
Module 2 - Minimum distribution guarantee for a non-national European film
(to be filled in and signed by the distributor)

Declaration on the applicant's honour

I, the undersigned, hereby declare on my honour:
•	that the applicant company is not in one of the exclusion cases listed in Section 6 of the guidelines of Call  EACEA/01/2011;
•	that it is a European company as defined in the guidelines applicable to this Call;
•	 that the project for which European Union support is requested is a non national European film as defined in Call for proposals EACEA/01/2011 and that the film does not consist of advertising, pornographic or racist material nor advocates violence;
•	that I am familiar with the Guidelines ``Support for Trans-national Distribution of European Films - The   Automatic Scheme`` of Call EACEA/01/2011 of the MEDIA 2007 Programme and that I accept and observe the conditions and procedures specified therein, particularly regarding matching funds; 
•	that the applicant company holds the theatrical distribution rights of the film applied for the territories and duration specified in this Reinvestment Project Form and that a copy of such contract is enclosed with this application;
•	that the information contained in this Reinvestment Project Form and the company form are true, verifiable and up-to-date;
•	that the company has the financial and operational capacity to complete the proposed action;
•	that I have been duly authorised by the applicant company to sign this application.
I am fully aware that my organisation is not entitled to receive more than one grant from the European Union Budget for the action covered by this application and will therefore withdraw any application for any other grant from the European Union Budget should this application be successful, or will withdraw this application should any other application be successful. 
I also agree to the publication of information about the grant award, should my application be successful.

Name of the legal representative: 			Date: 		
Signature of the legal representative:		
Legal name of the company:	………………………..

CHECK LIST
Identification of the company:
In case of modified circumstances since you sent the Agency your 2011 Company Form (change of ownership/shareholders/signatory, new financial year, change of the bank details...), a new company form must be filled in and sent with the corresponding documents.
Any modification that is not notified to the Agency may cause the delay or the cancellation of the financing and contracting of the selected project(s).

Please enclose the following documents :
	One copy of the distribution contract (with annexes and without alterations), signed with the producers and/or sales agent. The copy of the contract must contain the following  statement ‘copy certified as true’ together with the signature of the representative of the company (the contract must be signed on or after 1/08/2011).

	Production cost and corresponding financial plan of the film in national currency, certified by the delegate producer and/or by the relevant national authority.

If the information on the film and/or the distribution contract have already been supplied to the MEDIA Programme as a part of an application in response to previous calls for proposals, they need not be supplied on this occasion. A full list of all films which have already been qualified is available for consultation at: http://eacea.ec.europa.eu/media/films 

I. 	Information regarding the film

Original title: 		

Cast and crew list:

Director: 
Name: ..........................................	Nationality / Residence: 	

This film is the director’s

		1st feature film 		2nd feature film		other	

Script Writer: 
Name:		Nationality / Residence: 	

Main cast (official credits order):
Name: 		Nationality / Residence: 	
Name: 		Nationality / Residence: 	
Name: 		Nationality / Residence: 	

Composer:
Name: 		Nationality / Residence: 	

Production design (art direction):
Name: 		Nationality / Residence: 	

Director of photography:
Name: 		Nationality / Residence: 	

Editor:
Name: 		Nationality / Residence: 	

Sound:
Name: 		Nationality / Residence: 	

Shooting location: 		Country:		

Laboratory:		Country: 	

I. 	Information regarding the film

Original Title: 		

Local Title: 	

Genre:
		Fiction		Documentary		Animation
Length (in minutes): .	. Format:		
Shooting language:		
Year of copyright:    		
Cost of production: 	local currency 		in EURO (€).............................

Date of beginning of principal photography: 	

Date of completion of principal photography: 	

Financing Plan of the film

Please enclose the Financing Plan, including the Total Production Cost, certified by the lead producer. The Financing Plan should identify the (co)producer(s) of the film (as officially credited) and their share in the (co)production. 

Statement of confidentiality: the above requested document is strictly for the internal use of the MEDIA Programme and for qualification purposes only.

Producer (or Lead producer in case of international co-productions):

Name of the Company	Town	Country	% in the co-production
							
Co-producers:
Name of the Company	Town	Country	% in the co-production

							
							
	TOTAL		

World sales agent:
Name of the Company: 	
Street: 	.		Tel: 			
Town: 			Fax: 		
Country: 			E-mail	

II. 	Information regarding the distribution contract

Date of signature of the contract: 	

Amount of MG in currency of the contract: 	

Amount of MG in EURO (rate of the month of application, if relevant): 	€

Effective dates of payment of the minimum guarantee (if known, otherwise as per contract):

	%	Amount in currency	Date of payment

						

Territories of distribution

(I) National territory

Territory: 	
Period of licence for the national territory:   	
Rights licensed (other than theatrical distribution): 
Video:		rental 		sell-through	television: 	pay TV		Free TV
Other rights (please specify) 		

Forecast First Theatrical Release date in the national territory	

Number of prints forecast for first release:		

(II) Other territories

If the distributor acquired the distribution rights for other territories, please specify the following:

	Distribution territory 	% of MG corresponding to each territory of 
	distribution

			

III. 	Project budget

Expenses

Total amount of MG in Euro		
- deductions of territories other than national territory	- 	
Total eligible amount of MG		

Financing plan

	EUR	%	
Contribution requested from the MEDIA Programme 			
Other public support (please specify)
……………………………….………..			
Contribution financed by the distributor	-		
Total eligible amount of MG		100 %	

If the contribution request exceeds 25.000€, applicants should have already supplied all the documents related to the financial capacity as requested (see Company form). If they have not, they must provide the amended Company Form and the annual accounts with the Reinvestment Form (see section 7.2 of the guidelines). Please note that in such case, there will be a significant delay in the treatment of the application.

Name of the Legal Representative:

……………………………………….
	Date: ……………	
Signature of the Legal Representative

…………………………………………