APPLICATION FORM 
FILMS

I, the undersigned, hereby declare on my honour:
*	that the applicant company is appointed for the international sales of the theatrical distribution rights of the declared films, for the territories and duration specified in this Form and that a copy of the international sales contract/agreement is enclosed with this application;
*	that the films declared in this Form are recent European films as defined in the guidelines and that the films do not consist of advertising, pornographic or racist material nor advocate violence ;
*	that I am familiar with the guidelines “Support for the Transnational Distribution of European Films – Support to the International Sales Agents of European Cinematographic Films” of Call EACEA/06/2010 of the MEDIA Programme and that I accept and observe the conditions and procedures specified therein, particularly regarding matching funds;
*	that the information contained in this application form are true and verifiable;
*	that I have been duly authorised by the applicant company to sign this application.
I also agree to the publication of information about the grant award, should my application be successful.

 Signature of the Legal Representative  : 			Date : 		
Name of the applicant :		
Legal name of the company:           ……………………	

CHECK LIST

Applications failing to supply the necessary documents may be considered ineligible.

I.	Information concerning European films which the Sales Agent sold from 01/01/2006 to 31.12.2009

	Summary list of films 	

II.	Information regarding the international sales of the declared films:

		This part of the form (information regarding the international sales of every declared film) must absolutely be completed by the applicant sales agent, and signed by the legal representative of the applicant company, and accompanied by a copy (complete with annexes and without alterations) of the international sales contract/agreement with the producer with the handwritten statement " Copy certified as true" signed by the legal representative of the company (the contract can not be signed after 31/12/2009).

III. 	Information regarding the films:

	If the information on the film has already been provided to the MEDIA Programme, they need not be supplied on this occasion. A full list of all films on which full information has already been provided is available for consultation at: http://eacea.ec.europa.eu/media/films/

	If the information regarding the film has not yet been provided to the MEDIA Programme, please fill in Part III of the form and enclose the production cost and corresponding financial plan of the film in national currency, certified by the delegate producer and/or by the relevant national authority.

I.	List of European films sold by the sales agent from 01/01/2006 to 31/12/2009

This list must contain at least 8 European recent films (of which one non-national) for which the applicant sales agent was the appointed sales agent between 01/01/2006 and 31/12/2009. 
A list of the films declared as being in distribution between 01/01/2006 and 31/12/2009 in the framework of the automatic support schemes can be consulted on the website http://eacea.ec.europa.eu/media/films/

Summary list of films :

Enclosed:		Yes		Number of pages :	

Application form “Film”:

Number of application forms enclosed : 		

The international sales agent must enclose, for each of the films mentioned in the summary list:

- an application form “Film” duly completed and signed, unless the film has already been qualified by MEDIA (see http://eacea.ec.europa.eu/media/films/); 

- a copy (complete with annexes and without alterations) of the international sales contract/ agreement with the producer with the handwritten statement " Copy certified as true" signed by the legal representative of the company (the date of the contract must be on 31/12/09 at the latest), unless these documents were already submitted to the Executive Agency in response to a previous call for proposals in the framework of the MEDIA Programme.

SUMMARY LIST OF FILMS to be sent to Constantin DASKALAKIS (BOUR 3/30), MEDIA Programme, Avenue du Bourget 01, B-1140 BRUSSELS on or before 30 April 2010
SALES AGENT (Company name in full) :

This list must contain at least 8 recent European films (of which one non-national) for which the applicant sales agent was the appointed sales agent between 01/01/2006  and 31/12/2009. A list of the films declared as being in distribution between  01/01/2006 and 31/12/2009 in the framework of the automatic support schemes  can be consulted on website http://eacea.ec.europa.eu/media/films/ . NB. Do not include films whose first copyright has been established before 2006 and do not use other application form than THIS one see Eligible criteria.

Original Title of the film 
	Year of production (year of copyright)	Country of origin	Application form « Film » enclosed	International license agreement signed with producer enclosed	

					

Certified as true : 

Date : 
	Signature of legal representative of the company :………………….

II. Information regarding the international sales of the declared films
	(This part of the form must be completed and signed. Please do not modify this form.)

Original title of the film :	

Date of signature of the contract with the producer : 	
Please enclose a copy (complete with annexes and without alterations) of the international sales contract / agreement with the producer with the hand written statement " Copy certified as true" signed by the legal representative of the company (the date of the contract must be on 31/12/2009 at the latest and started before that date).

Country	Territory included in the Sales agents contract with the producer
(if yes, mark an «X »)	Theatrical Rights  released  in the territory between 01/01/06 and 31/12/2010
(if yes, mark an «X »)	Name of the licensee distributor	
Austria (AT)				
Belgium (BE)				
Bulgaria (BG)				
Croatia (HR)				
Cyprus (CY)				
Czech Republic (CZ)				
Denmark (DA)				
Germany (DE)				
Estonia (EE)				
Spain (ES)				
Finland (FI)				
France (FR)				
Greece (GR)				
Hungary (HU)				
Eire - Ireland (IE)				
Iceland (IS)				
Italy (IT)				
Liechtenstein (LI)				
Luxembourg (LU)				
Latvia (LV)				
Lithuania (LT)				
Malta (MT)				
Netherlands (NL)				
Norway (NO)				
Poland (PL)				
Portugal (PT)				
Romania (RO)				
Slovakia (SK)				
Slovenia (SI)				
Sweden (SU)				
Switzerland (CH)				
United Kingdom (UK)				

Certified as true, 

Date : 			Signature		

III.	Information on the declared films:

For each film that has not yet been qualified by MEDIA, the applicant sales agent must fill in this form and send two copies of it.

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 :
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 : 	

Genre : 
		Fiction		Documentary		Animation
Length (in minutes) :		Format :		
Date of start of principal photography: …………………………………………………………..
Date of completion of principal photography : 	
Shooting language : 		
Year of copyright :    		
Cost of production : in local currency …	in EUR	...........................………

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 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