MEDIA 2007 (2007-2013)
Call for Proposals EACEA/04/2010
Pilot Projects

Application Form

Council Decision N° 1718/2006/EC
of the European Parliament and the Council

Conditions of Submission

1. Proposal language

All sections must be completed, preferably in English, in order to be of assistance to the evaluators. In any case the applicants are requested to attach a translation of the abstract and an extended summary of the proposal in English.

2. Application form

Applications may only be submitted using this form. The Agency will accept only printed forms which have not been modified and which have been completed correctly, in full. The annexes requested may be hand-written. Please respect the format provided and follow the page order. You are strongly advised to read through the entire application form before beginning to complete it.

This form is available on the Internet and can be downloaded (in word format) at the following address, as well as the budget form (in excel):
http://ec.europa.eu/information_society/media

The application comprises two parts and five annexes (see section 5.6.2. of the Guidelines).

Part A collects administrative information about the proposal and its proposers (e.g. title of the proposed action, proposer’s names and addresses, brief description of the work, total funding requested by type of expenditure, etc.).

Part B asks for a detailed description of the nature of the proposed action. Part B should also identify and describe the partners and their responsibilities within the proposed action.

The annexes requested are necessary to provide the Agency with additional administrative information to assist in the preparation of a contract if the proposal is successful.

3. Guidelines

Before completing the application form, please read these guidelines. The Agency reserves the right not to consider applications, which do not provide all of the information requested. Applications, which do not comply with the eligibility criteria detailed in these guidelines, will not be considered.

Applicants are requested to submit a detailed budget for each 12-month period, as well as a general forecast for the full period of the project (2 or 3 years). However their selection will be made on a yearly basis and will depend on results obtained and evolution at the moment of evaluation.

Particular attention should be given to the Financial Conditions (see section 9. of the Guidelines). Any costs presented in the budget which do not comply with the Financial Conditions will be considered as ineligible and will not be taken into account when calculating the support to be awarded.

4. Number of copies

Applicants are required to present one signed original application form completed with the requested annexes and two copies (including copies of the annexes.)

In addition to these, an electronic copy of the application shall be included on CD-Rom / DVD-Rom.

5. Deadline for reception

All applications must be sent by registered mail or courier service (at the applicant's own expense) by 14/06/2010. The postmark will be taken as proof of timely submission.

6. Presentation and delivery

Proposals must be clearly marked with the following words: "MEDIA Programme – Pilot Projects – EACEA/04/2010" to the following address:

Education, Audiovisual and Culture Executive Agency
MEDIA Programme – Pilot Projects – EACEA/04/2010
Mr Constantin Daskalakis (BOUR 03/30)
Avenue du Bourget 1
B - 1049 Brussels
Belgium

Applications delivered by hand or by private courier (which must be at the applicant's own expense) should be delivered to the following address: 

Avenue du Bourget 1, B-1140 Brussels (Evere), Belgium

Proposals delivered by hand must arrive before 3.00 pm on the relevant deadline.

Applications sent by fax or email will not be accepted.

Part A: Administrative Information

1- ACTION FOR WHICH THE APPLICATION IS BEING MADE (double click in box to tick)	

ACTION 1: Distribution: new ways of creating and distributing European audiovisual content via non linear services.	

ACTION 2: Open Media Production Environment	

ACTION 3: Distribution - Promotion & Marketing: the use of web techniques to develop local Cinema Communities.	

ACTION 4: Junction Media Portal: to widen and improve the access and the exploitation of structured information of European audiovisual content	

ACTION 5: Previously funded Pilot Projects: Actions which have received funding under a previous MEDIA - Pilot Projects Call for Proposals.	

2- TITLE OF ACTION	

Action title: 

Acronym (if any): 

Reference N° (for office use only):

	
3- DURATION OF PILOT PROJECT (double click in box to tick)	

12 Months	
24 Months	
36 Months	

4- ORGANISATION RESPONSIBLE FOR THE ACTION (co-ordinator)	

Full legal Name:

Legal Address:

Tel (Office):

Fax:

Tel (Mobile):

E-mail: 

Legal status: 

Correspondence address (if different):

	

5- PERSON IN CHARGE OF THE ACTION WITHIN THE ABOVE ORGANISATION (who will be authorised to sign the Agreement for MEDIA support if the application is selected)	

Name:

Function:

Address:

Tel (Office):

Fax:

Tel (Mobile):

E-mail: 

6- BRIEF DESCRIPTION OF ACTION (maximum 1000 characters)	

	

7- ACTION BUDGET
The next two pages are the templates for the budget (7.1 – Expenditure & 7.2 – Income).
The budget must be balanced and should indicate clearly the budgetary year. It must be initialled on every page by the legal representative of the co-ordinator.
Please fill in one budget (expenditure and income) for every year of the action in order to show an overview of the costs for subsequent years.
However the financial contribution requested from the MEDIA 2007 Programme may only be awarded for the current year. Any further contribution will be subject to a new application for the action.	

Signature: ………….	
YEAR:	
7.1	Estimated Budget	Rate per Day or Unit Price	Number of Days or Units	in Euro	% of total costs	
Personnel costs, travel & subsistence costs & any budget item should be broken down in detail	
 	 	 	 	 	
1 - Personnel Costs	 		 	 	
(please specify Name & Job Title)	 		 	 	
1.1. - Management Staff (Managers, Executives…)	 		 	 	
 					
1.2. - Assistants, Secretaries, Temporary Staff	 		 	 	
 	 		 	 	
1.3. - Miscellaneous Staff (e.g. IT, accountancy…)	 		 	 	
 	 	 	 	 	
TOTAL Heading 1	 	 	 	 	
					
2 - Operating Costs	 		 	 	
(please specify)	 		 	 	
2.1 - Travel and Subsistence Costs	 		 	 	
 	 		 	 	
2.2 - Durable Equipment	 		 	 	
 	 		 	 	
2.3 - Advertising and Promotion Costs	 		 	 	
 	 		 	 	
2.4 - Costs of Bank Guarantee	 		 	 	
					
2.5 - Other Operating Costs					
	 		 	 	
TOTAL Heading 2	 	 	 	 	
					
3 - Sub-contracting Costs	 		 	 	
Limited to 30% of the total eligible costs	 		 	 	
(please specify)	 		 	 	
	 		 	 	
TOTAL Heading 3	 	 	 	 	
 	 		 	 	
4 - Reporting Costs					
					
4.1 - Costs of the certification by the Approved External Auditor					
 	 		 	 	
TOTAL Heading 4	 	 	 	 	
 	 	 	 	 	
SUB-TOTAL (1+2+3+4)	 			 	
 	 	 	 	 	
 	 	maximum	 	 	
Overheads: May not exceed 7% of the total eligible costs (Sub-total)	 		 	 	

TOTAL in Euro	 			 	

MEDIA BUDGET – Explanatory note 

The estimated budget as well as the final report has to be presented in exactly the same way and structured as follows:

	1.	Heading (level to verify the transfers allowed)
	1.1.	Sub-heading (expense category)
	1.1.1.	Item (expense level)
1.1.1.1.	Sub-item (detail of expense level)

To avoid rejection of expenses when submitting the final report, rules described below must be respected when carrying out the action:

1. Heading
The number of headings cannot be changed after the signature of the contract, even through an amendment. 

1.1. Sub-heading
Additional sub-headings can be added through a prior amendment to the initial eligible estimated budget. 

1.1.1. Item
Additional Items can be added through a simple prior written approval by the Agency. 

1.1.1.1. Sub-item
Additional sub-items can be added by the Beneficiary without prior Agency approval as far as the sum of the new sub-items is not superior to the total of the existing specific sub-items, already mentioned in the eligible estimated budget. 

•	As specified in the agreement art II.14.1, to be considered as eligible costs of the action, costs must be provided for in the estimated budget. To satisfy this requirement, sub-heading level will be considered.   

•	Should the transfers between headings exceed the limit of 10% specified in art I.3.4, the provisions of art II.13.3 apply and prior amendment has to be requested by the beneficiary providing a modified estimated budget. It is to be noted that the total of the estimated budget cannot be changed.

Signature: ………….	
YEAR:	
7.2	Financing Plan	Type of Document	Date of Signature	in Euro	% of total costs	

1 - Own Resources	 		 	 	
 	 		 	 	
- Applicant's Investment					
 					
- Action's Revenues 	 		 	 	

2 - Private Sources	 		 	 	
(contributions in kind cannot be included)	 		 	 	
	 		 	 	
Please indicate names of companies and amounts of	 		 	 	
co-financing	 		 	 	

 	 		 	 	
3 - Public Funding other than MEDIA 2007	 		 	 	
(local, regional, national and supranational sources)	 		 	 	
	 		 	 	
Please indicate names of funding bodies and amounts	 		 	 	
of support	 		 	 	

 	 	 	 	 	
4 - Financial contribution requested from the	 		 	 	
MEDIA 2007 Programme	 		 	 	

TOTAL INCOME in Euro	 			 	
 	 		 	 	
The budget must be balanced, i.e. Income (Part 7.2), including the financial contribution requested from the MEDIA 2007 Programme, must match Expenditure (Part 7.1). Otherwise the Agency reserves the right not to accept the application.	

Signature of the legal representative

Date	

7.3- NOTE TO THE ESTIMATED BUDGET
This Note should justify the costs incurred under the various Budget Headings and establish the direct link with the execution of the Action. Attention should be given to the details requested in Section 9 of the Guidelines.

(To be continued on an additional sheet if necessary)	

Part B: Presentation of the Proposed Action

8- OBJECTIVES
This section should not exceed two pages. The objectives should be achievable within the action's period, not through any subsequent developments, and should be quantifiable and verifiable. Evaluations will measure the progress of the action work against these objectives.
(To be continued on an additional sheet if necessary)	

9- ACTION Partners
(to be filled in for each partner of the action, INCLUDING the co-ordinator), 	

9.1 - ADMINISTRATIVE INFORMATION (to be filled in for each partner of the action)	
Name of Partner	Type of Activity	Reg. nr	
			
Signatory name	Contact name (if different)	VAT nr	
			
Phone nr	Fax nr	Mobile nr	
			
e-mail	Official registered address		

9.2 - Description of PARTNERS (to be filled in for each partner of the action)
This section, should provide a short description of participating organisations and key persons involved:
1. Short profile of each organisation participating in the action (no more than two pages per organisation)
2. Short CVs of the key persons to be involved (no more than one page per CV), stating their function within the action
3. How organisations and key people complement each other (no more than one page)
(To be continued on additional sheets if necessary)	

9.3 - DECLARATION (to be filled in for each partner of the project)	

I, the undersigned (First Name, Last Name), acting as (Position) for (Full Organisation Name), certify that the organisation I manage is registered in an eligible country (as defined in section 5.2 of the Guidelines).
I hereby confirm:
•	that the content of the action, for which support is requested, does not consist of advertising, pornographic or racist material nor advocates violence; 
•	that I am familiar with the "Guidelines for Pilot Projects" to Call for Proposals EACEA/04/2010 of the MEDIA 2007 Programme and that I accept and observe the conditions and procedures specified therein;
•	that I strictly respect the confidentiality of any document (including the contents of sealed envelopes) I receive from the partners of the action;
•	that the information contained in this application form is true and verifiable;
•	that the person signing this application has been duly authorised by the company to do so.
•	that I, in the name of (Full Organisation Name), designate (Full Name of the Organisation co-ordinating the action) as the Co-ordinator of (Action Name) in the event of a grant agreement with the Agency.
•	that, should a MEDIA support be granted and the source of co-financing declared in the estimated budget not be confirmed yet, the Co-ordinator undertakes to guarantee financial cover for the action;
•	that I have the financial and operational capacity to complete the proposed action.

Place:      	Date    /    /      (day/month/year)

Signature	Name of the Organisation

Name and position in capitals	Stamp of the applicant / contracting organisation

	

10- ACTION WORK PLAN
This section, which should not exceed 20 pages, describes the work planned in order to achieve the objectives of the action. Essential elements of the work plan:
1. Introduction, explaining the structure of the work plan and the methodology that enables achievement of the action
2. Work plan of the action, showing the timing of the work to be accomplished
3. Graphical presentation of the action’s components, illustrating their separate elements
4. Detailed action description including identification of significant risks and contingency plans.
(To be continued on additional sheets if necessary)	

11- ACTION'S CONTRIBUTION TO THE OBJECTIVE OF THE PILOT PROJECTS SCHEME
According to Decision 1718/2006/EC, the objective of the Pilot Projects scheme is to ensure that the programme adapts to market developments, mainly in connection with the introductions and use of information and communication technologies.
This section should identify the priorities of the submitted project and in which way, the action contributes to the above mentioned objective
Each part of this section is limited to one page.	

11.1 – Please explain how the submitted action contributes to the objectives of the Pilot Projects scheme.
11.2 – Please describe the extent and the potential of the European Dimension of submitted action, in terms of origin of the content, target audience and network of partners.
11.3 – Please describe the envisaged strategies of the submitted action, in order to reach the planned objectives and target audience…
11.4 – Please explain in a concise manner the financial strategy and choices made in order to realise the action.
11.5 – Please describe briefly the management plan and the added value of the partners.
11.6 – Please describe the plan for dissemination of the results.
11.7 – Please describe clearly the nature and choice of the technology to be used for the purpose of the submitted action.
(To be continued on an additional sheet if necessary)	

12- MANAGEMENT
This section, which should not exceed five pages, should describe the management structure and management planning for the action, the decision making structures to be applied, the communication flow within the grouping, the quality assurance measures to be implemented, and should demonstrate how changes will be controlled and any conflicts resolved.
(To be continued on an additional sheet if necessary)	

13- ECONOMIC DEVELOPMENT
This section, which should not exceed five pages, should highlight future plans. The action should clearly identify the conditions required to maximise project success. Strategic impact of the proposed action in terms of improvement of competitiveness or creation of markets and of market opportunities for the participants should be described. This should include assessment of market size, competition, pricing and potential sales.
(To be continued on an additional sheet if necessary)	

Annexes

Please fill in and attach the following annexes in the correct order, as required. The following annexes must be filled by the co-ordinator of the action ONLY.

•	Annex I: Financial Identification (Bank detail sheet to be completed and signed by bank manager and authorised signatory of applicant organisation)
A template is available on: http://ec.europa.eu/budget/execution/ftiers_en.htm
•	Annex II: Legal entity form
A template is available on: http://ec.europa.eu/budget/execution/legal_entities_en.htm
•	Annex III: Financial Capacity form
•	Annex IV: Declaration
•	Annex V: Acknowledgement of Receipt

Annex I: Financial Identification

SPECIMEN

Annex II: Legal Entity Form

SPECIMEN

PLEASE USE THE FORM RELEVANT TO THE NATURE OF THE APPLICANT ORGANISATION. THESE FORMS ARE AVAILABLE ON THE WEBSITE:
http://ec.europa.eu/budget/execution/legal_entities_en.htm 

Annex III: Financial Capacity

Funding of the action

Total costs of the action: 	EUR 
Amount requested from the MEDIA Programme: 	EUR 
Other funds already obtained for the action (not from MEDIA): 	EUR 
Total number of months of the action (max 18 months): 	

Tick the relevant box for the coordinator of the applicant organisation: 

	If the applicant is a commercial company: therefore the applicant has enclosed its complete annual accounts for the last 2 years. 
	If the applicant is a non-profit organisation: therefore the applicant has enclosed its complete annual accounts for the last year.
	If the applicant is a public law body: it requests to be exempted from the verification of its financial capacity.
	If the amount requested to the MEDIA Programme for the action submitted under the current call is up to EUR 25 000: therefore the applicant requests to be exempted from the verification of its financial capacity. The applicant certifies through the declaration of honour that it has the financial capacity to implement the action to be granted (see Application Forms).
	If the applicant is an individual, bank details form, duly completed and signed photocopy of identity card and/or passport.

Declaration on honour (as per Call for proposals - Section 7.2)

If you are exempted from the verification of the financial capacity, Please read carefully before you sign the declaration on honour certifying that you have the financial capacity and sufficient sources of funding to maintain your activity throughout the lifetime of the action (see annex to the Application Form).

To be provided ONLY if your organisation is NOT exempted from the verification of its financial capacity:

Please specify whether in accordance with your national legislation, the annual accounts have been:

Approved by:
 	Board 				 	General Assembly		
 	Other (please specify)……………………………………………………………………
Date:…………………………………Signed by:……………………....………………….
Position:……………………………………………………………………………………

Certified by:
 	an approved auditor external to the company in compliance with the Directive 2006/43/EC of the European Parliament and of the Council of 17 May 2006 on statutory audits of annual accounts and consolidated accounts.

Supporting documents to be annexed to this form

- For commercial companies: Complete and certified annual accounts (balance sheet, profit and loss account and the annexes) for the 2 most recent years available
- For non profit companies:  Complete and certified annual accounts (balance sheet, profit and loss account and the annexes) for the most recent year available
- For individuals: bank details form, duly completed and signed and photocopy of identity card and/or passport

Depending on the legal status of your company/organisation, please fill in point a) or point b)

a) NON-PROFIT ORGANISATION ONLY

When not exempted from the calculation of its financial capacity, the applicant must provide the figures requested based on the most recent complete annual accounts enclosed with this application 
	
Financial Year: 	…………			Currency:	…………

Information to be extracted from the Balance Sheet 

Equity (Capital and reserves ):								

Formation expenses										

Total assets:                                         	      										

Information to be extracted from the Profit and Loss Account 
Profit or loss for the financial year before income tax:					
Total costs:											

b) COMMERCIAL COMPANIES ONLY

When not exempted from the calculation of its financial capacity, the applicant must provide the figures requested based on the complete annual accounts for the two most recent years enclosed with this application :
	
Financial Year: 	…………			Currency:	…………

PLEASE NOTE THAT THE FOLLOWING INFORMATION MUST BE PROVIDED FOR THE LAST 3 YEARS WHEN AVAILABLE: 

Accounting year:					………..		………..		…………..
Profit/loss of the financial year after tax			………..		………..		…………..
Depreciations						………..		………..		…………..
Dividends						………..		………..		…………..

Equity (Capital and reserves)				………..
Total assets 						………..
Current assets						………..
Current liabilities					………..
Total costs from the Profit & Loss account		………..

Date:	………………………………………….
Name:	………………………………………….

Signature of the applicant's legal representative:

Ongoing grants and new applications under review (This must be filled in by all applicants.)

Ongoing subsidies granted by the Media Programme in the course of the last three years and request for subsidy in Progress. In this case, specify "P" in the column "status" (if the support is granted, the applicant must inform the MEDIA programme of it).	
Title & reference of the action	Status (O/P)	Total costs of the action	Media contribution	Duration of the action (years/months)	

					

Annex IV: Declaration

I, the undersigned, certify that all information contained in this application and annexes, including the action description, is correct to the best of my knowledge. 
I confirm that my organisation has the financial and operational capacity to complete the proposed action.
I take note that under the provisions of the Financial Regulation applicable to the general budget of the European Union, grants may not be awarded to applicants who are in any of the following situations:
(a) if they are bankrupt or being wound up, are having their affairs administered by the courts, have entered into an arrangement with creditors, have suspended business activities, are the subject of proceedings concerning those matters, or are in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
(b) if they have been convicted of an offence concerning their professional conduct by a judgment which has the force of res judicata;
(c) if they have been guilty of grave professional misconduct proven by any means which the contracting authority can justify;
(d) if they have not fulfilled obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the country in which they are established or with those of the country of the contracting authority or those of the country where the contract is to be performed;
(e) if they have been the subject of a judgment which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the Union's financial interests;
(f) if following another procurement procedure or grant award procedure financed by the Union budget, they have been declared to be in serious breach of contract for failure to comply with their contractual obligations.
(g) if, in their grant application, they are subject to a conflict of interest;
(h) if, in their grant application, they are guilty of misrepresentation in supplying the information required by the contracting authority as a condition of participation in the grant award procedure or fail to supply this information. 
I confirm that neither I nor the institution for which I am acting as legal representative are in any of the situations described above, and am aware that the penalties set out in the Financial Regulation may be applied in the case of a false declaration.
In the event that my grant application is successful, I authorise the Commission/ Agency to publish on its Internet site or in any other appropriate medium:
•	The name and address of the beneficiary of the grant;
•	The subject of the grant;
•	The amount awarded and the rate of funding of the costs of the approved work programme. 
	
Place:      	Date    /    /      (day/month/year)

Signature of the legal representative	Stamp of the applicant / contracting organisation

Name and position in capitals

Annex V: Acknowledgement of Receipt

To be completed by the applicant

Address to which acknowledgement should be sent:

(Complete the right-hand column)

	

	

MEDIA 2007 (2007-2013)

Call for Proposals EACEA/04/2010

Pilot Projects

Education, Audiovisual and Culture Executive Agency	

ACKNOWLEDGEMENT OF RECEIPT

To be completed by the applicant

Application form for action entitled:

Reference number to be quoted in all correspondence (will be attributed by the Agency):

1004 PP01 

Education, Audiovisual and Culture Executive Agency

Checklist

This checklist will help you check that your proposal is complete and meets all the eligibility criteria and formal requirements of the programme. Your project will be evaluated only if your application fulfils all the following criteria:

	Administrative information about the submitted Action and the applicant organisation (A.1 to A.5)

	Brief description of the Action (A.6)

	Action Budget: Expenditure and Income (A.7.1 & A.7.2) initialled on every page

	Action Objectives: Content and Strategies for Commercialisation (B.8)

	Action Partners (for each partner): 
•	Administrative information (B.9.1)
•	Description of the organisation (B.9.2), including CVs of the key persons and short profiles of the organisations involved in the action
•	DECLARATION signed, stamped and dated (B.9.3)

	Action Work Plan (B.10)

	Action 's Contribution to the objective of the Online Distribution scheme (B.11)

	Management (B.12)

	Economic Development (B.13)

	Mid-term Activity & Financial Reports from the previous period (for projects already supported)

	Financial Identification Form (Annex I)

	Legal Entity Form (Annex II), together with:
•	a copy of the statutes of the applicant organisation
•	the official registration document
•	the VAT registration document

	Financial Capacity Form (Annex III), together with (only for the co-ordinator):
•	the balance sheet for the last fiscal year
•	the profit & loss account for the last fiscal year
•	when the requested contribution from MEDIA 2007 is higher than € 750,000, the full audited accounts for the last fiscal year, certified by an approved auditor

	Declaration signed, stamped and dated (Annex IV)

	Acknowledgement of Receipt (Annex VI)

	Does your action fulfil the European dimension criterion (i.e. content from at least four eligible countries representing at least three different official languages of the European Union)?

	Is the budget presented in conformity with the format and instructions of the application form?

	Have all sections (of Part A & B) of your application been printed? (Hand-written documents are not acceptable)

	Have you submitted one signed and dated original application form and two copies?

	Have you included an electronic copy of the entire application on CD-Rom / DVD-Rom?