Declaration on the applicant's honour
I, the undersigned, hereby request a grant from the Education, Audiovisual and Culture Executive Agency of EUR ………… ………………… to implement the action covered by this grant application.
I, the undersigned, certify that all information contained in this application, is correct to the best of my knowledge and that I am aware of the content of the annexes to the application form.
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 Communities, 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 Communities' financial interests;
f) if, following another procurement procedure or grant award procedure financed by the Community 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 organisation for which I am acting as legal representative are in any of the situations described above, and that I am aware that the penalties set out in the Financial Regulation may be applied in the case of a false declaration.
Should my grant application be successful, I authorise the Commission/the Agency to publish on its website 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 project.

By signing this application form, I confirm that that my organisation fulfils the eligibility criteria related to the eligible applicants as defined in section 5.1 of the guidelines and  I accept all the conditions set out in the ‘Media Programme’ (2007-2013) Development Guidelines including the general conditions of the European Commission published on the Executive Agency website.. 

Signature………………………………..			Date:

Name and First Name…………..	……..			Done at (state location):