REINVESTMENT PROJECT FORM
Module 1 – Co-production of 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/07/2012;
•	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/07/2012 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/07/2012 of the MEDIA 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 2012 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 synopsis of the film in English or in French

	Copy (complete with annexes and without alterations) of the co-production contract with the hand written statement "Copy certified as true" signed by the legal representative of the company (the contract must be signed on or after 1/10/2012)
	One copy of the forecast budget and financing plan of the production (duly dated and signed by the lead producer).
If the information on the film and/or the co-production 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: 		
International Title: 	
Title of the script (if different from the title of the film): 	
Genre:
		Fiction		Documentary		Animation

Forecast Length (in minutes): 	. Forecast Format:		
Date of beginning of principal photography: 	
Date of completion of principal photography: 	
Shooting language:		
(Enclose a short synopsis in English or French)

At the date of signature of the co-production agreement, the project was at the following stage:

     Development. 	   Shooting.

     Pre-production. 	   Post-production.

  Delivery date: 	

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: 	

II. 	Information regarding the co-production:

Lead Producer:

Name of the company: 		
Contact: 		
Contact’s position in the company: 		

Address for correspondence
Street: 	.....................................................		Tel: 	
Town : 			Fax : 	
Post Code : 		E-mail	
Country: 		

Coproducers :

Coproducer 1

Name of the company: 		
Contact: 		
Contact’s position in the company: 		

Address for correspondence
Street: 	.....................................................		Tel: 	
Town : 			Fax : 	
Post Code : 		E-mail	
Country: 		

Coproducer 2

Name of the company : 		
Contact : 		
Contact’s position in the company : 		

Address for correspondence
Street : 	.....................................................		Tel : 	
Town : 			Fax : 	
Post Code : 		E-mail	
Country : 		

Coproducer 3

Name of the company: 		
Contact: 		
Contact’s position in the company: 		

Address for correspondence
Street: 	.....................................................		Tel : 	
Town : 			Fax : 	
Post Code : 		E-mail	
Country: 		

World Sales Agent:

Name of the company: 		

Address for correspondence
Street: 	.....................................................		Tel : 	
Town : 			Fax : 	
Post Code : 		E-mail	
Country : 	

Co-production contract 

Date of signature: 		

Signed between the distributor and the company: 	

Estimated total cost of the co-production in currency: 	

Estimated total cost of the co-production in EURO: 	€

Distributor’s investment in the co-production in currency: 	

Distributor’s investment in the co-production 
in % of the total estimated co-production cost: ……………..………………………….%

Distributor’s investment in the co-production in Euros: 	€
(Enclose the forecast budget and financing plan of the film dated and signed by the lead producer)

Financing plan of the distributor’s investment in the co-production:

	EUROS	%	
Contribution requested from the MEDIA Programme			
National public support
				
Other European support (please specify)
……………………….…			
Distributor’s investment
			
TOTAL		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: ...........................