Professional Documents
Culture Documents
PROGRAMME 2014-2020
MNE - NASRI
INTERMEDIATE BODY FOR RESEARCH
APPLICATION FORM
Content
1. INFORMATION ABOUT THE APPLICANT
2. INFORMATION ABOUT THE LEGAL REPRESENTATIVE AND PROJECT MANAGER
3. INFORMATION ABOUT OTHER PUBLIC FUNDING IN THE LAST 3 YEARS
4. INFORMATION ABOUT THE PROJECT
5. INDICATORS
6. SUSTAINABILITY OF THE PROJECT
7. COMPLIANCE WITH EU POLICIES AND NATIONAL LEGISLATION
7.1 POLLUTER PAYS PRINCIPLE
7.2 SUSTAINABLE DEVELOPMENT
7.3 EQUAL OPPORTUNITIES
7.4 PROCUREMENT
8. PROJECT FUNDING PACKAGE
8.1 COST DETAILS FOR EACH CATEGORY OF EXPENDITURE
8.2 PROJECT FUNDING PACKAGE
9. LIST OF ASSETS PROCURED DURING THE PROJECT
1.2 Legal Type of Applicant < tick one of the following >
a) Institution from the national research and development system ranked A+
according to the GD no 1062/2011 regarding the approval of the Methodological
Norms for the evaluation and classification of the institutions of the national R & D
system
b) Institution from the national research and development system ranked A
according to the GD no 1062/2011 regarding the approval of the Methodological
Norms for the evaluation and classification of the institutions of the national R & D
system
c) Certified High Education Institution classified as advanced reserach and education
institution according to the Education Law no 1/2011 as further amended and
supplemented
d) Certified High Education Institution classified as university of education and
scientific research according to the Education Law no 1/2011 as further amended and
supplemented
Region:
County/District:
City:
Address: < full address together
with zip code >
1.5 Sole Registration Code
< SRC>
< written as RO XXXX ; fill in only if the organization is VAT payer >
< fill in with the sector/sectors the outputs of the project address to>
1.9 BANK
Bank/ Branch
Address
IBAN Account No.
4
Position
Phone
Fax
YES
NO
< If yes, please fill in the table below with information for maximum 10 projects (presented in the descending
sequence of calendar years since the financing contract was signed) >:
Crt.
No.
Name of the institution the The budget of the The sum allocated Year of starting Year of ending
contract was signed with and the financing
to the applicant in the
financing the financing
name of the programme
contract
the
financing contract
contract
contract
(thousand RON)
(1)
(2)
(3)
(4)
(thousand RON)
(5)
(6)
(7)
...
< In column 2 write the full title of the project and its reference number/SMIS Code/no. of the financing contract.
In column 3 write the name of the institution the contract was signed with and the full name of the programme.
In column 4 write the total budget of the contract, including VAT and the certified value if the project ended or the value mentioned in the contract/the latest
additional act if the project has not ended yet.
In column 5 write the value of the sum allocated to the applicant in the financing contract, if the contract was concluded in partnership, according the column
4; the sum must be written in RON, including VAT.>
3.2 Has the present project proposal or its activities been granted non-reimbursable assistance from public
funds (European funds, funds from bilateral agreements, public governmental funds, loans from international
financing institutions, such as BERD/BEI/World Bank) in the last 3 years?
YES
NO
< If yes, please write which projects from point 3.1 >
3.3 For the present project proposal or its activities, are there any requests for funding within other
programmes at the moment of submitting the present application form?
YES
< If yes, please fill in the table below>
The programme the project was submitted
The date of submission
Stage of evaluation
NO
<registration no.>
<write the stage according to the latest documents you
received from the institution the project was submitted
to >
COP
Priority Axis
Action
1.1.1
Building new research centers, institutes and laboratories and
providing them with equipment and research tools
Type of project
< write one or more sub-areas (x,y,z name) from the list in Annex 3 to
the Guide for Applicant >
7
County
City
Full Address
Name
Relation
Crt.
No.
1.
2.
3.
....
< Present the way the investment you propose is addressed also to other national or sectoral strategies or/and
regional innovation strategies, the way the results of the project lead to reaching the objectives of the
strategies you identified. >
4.6 Direct beneficiaries
<Write the direct beneficiaries of the project and how the enterprises will benefit from the results of the
project. This section must be correlated with point 4.5 and the supplementary documents submitted.>
8
(1)
1. Procurement of land
(2)
Non-eligible
Sub-activity
Eligible
Activity
(3)
(4)
1.1 Sub-activity .
1.2 Sub-activity .
1.x Sub-activity .
2. Construction/modernization/
2.1 Sub-activity
Extension/consolidation/change
2.2 Sub-activity
destination of constructions
designed to
institutes/centers/laboratories
2.x Sub-activity
3. Procurement of tangible
assests: buildings and/or areas
3.1 Sub-activity
3.2 Sub-activity
3.x Sub-activity
4. Procurement of tangible
...
10
Duration
Full
Duration
Starting
Date
Quantified Results
End Date
(month)
(no. of (month)
months )
(5)
(6)
(7)
(8)
...
...
5. Procurement of intangible
assets for R&D
...
...
...
...
...
...
7. Project management
...
...
...
11
4.7.2
Responsibilities
Crt.
No.
Name
Responsibilities
5. INDICATORS *
< Fill in the indicators for each type of project, as they are presented in chapter 4 in the Guide for
Applicant. The applicant may also write additional indicators here.>
Output
code
CO25
CO24
Result
Indicators
3S2
3S1
Output indicators
Value at the
begining of the
implementation
period
Value at the
beginning of
implementing
project activities
** From the list of these indicators choose the indicators proposed for the project, whose binding targets are mandatory to be
achieved and will be further monitored. Other indicators can be proposed
< Present the way the implementation of project results will be sustained from administrative, technical
and financila point of view after the end of the project. For project including investment, the information
provided here must be in compliance with the Feasibility Study, where the institutional and financial
feasibility of investment is justified. >
7.4 PROCUREMENT
Crt.
No.
Type of Procurement
(services/
assets/
works)
Purpose
Estimated Value
(RON)
Estimated
date for
starting the
procedure*
Estimated
date for
completing
the
procedure*
1
2
3
....
.
< *write the number of the month (i.e. Month 3) in compliance with the information provided at point
4.7.1 in the Application Form >
14
Code
Expenditure
Expenditure
value
(RON)
Eligible
value
(RON)*
Noneligible
value
(RON)
Intensity of
public
intervention
(%)
B1
B1.1
B 1.2
Procurement of land
Works expenditures
Construction / modernization /
expansion / consolidation /
modification / change
destination buildings
(according to the general
estimate of SF / DALI)
Procurement and and
improving the land (except
head 1.1 Procurement of land
which will mentiones at cap A
above)
Ensure the necessary utilities
(excluding costs for industrial
railway)
B 1.3
B1.4
Basic investment
B 1.5
B.2
15
- RON
Nonreimbursable
financial
assistance value
(RON)
7
C
C1
C2
D
Procurement of tangible
assets
IT and communication
equipment
Equipment and tools for
independent research
Procurement of intangible
assets
D.1
IT applications
D.2
Licenses
Purchase of buildings
F
G
VAT
...
TOTAL NON-ELIGIBLE
EXPENDITURE
(Total
(Total
(Total non(Nonproject
eligible
eligible
reimbursable
budget)
value)
value)
assistance value)
Attention! Some categories of expenditure are eligible to a certain percentage; carefully read the
guide specific section
TOTAL GENERAL
COMPONENTS OF PROJECT
BUDGET
TOTAL VALUE OF THE
PROJECT
16
- RON VALUE
II
NON-ELIGIBLE VALUE OF
THE PROJECT
III
III.1
NON-REIMBURSABLE FINANCIAL
ASSISTANCE
REQUESTED
III.2
III.2.1
III.2.2
III.2.3
Contribution in cash
Not applicable
Contribution in kind
Loan
Name
No of items
Technical characteristics
No of items
Technical characteristics
Name
17
Period
Degrees or diplomas
7. Professional experience:
Institution
Period
Position
Description
8. Foreign Languages:
9. Competence in Investment Area:
10.
er Specializations and Qualifications:
Oth
11.
Exp
erience (including managerial experience) in other national/international programmes/
projects:
Programme/Project
Position
Period
12.
er relevant information:
Administrated
Budget
Oth
18
19
CV OF THE PROJECT OPERATION TEAM(for project including investment, please attach the
CVS OF EXPERIENCED MEMBERS FROM THE RESEARCH TEAMS WHO ARE GOING TO
USE THE RD FACILITIES DEVELOPED BY THE PROJECT) (max. 15)
Please fill in a CV of max. 1-2 pages for each person in the project implementation team, following the
template below:
Institution:
Position within the Project:
1. Last Name:
2. First Name:
3. Date and Place of Birth:
4. Citizenship:
5. Marital Status:
6. Education:
Institution
Period
Degrees or diplomas
7. Professional experience:
Institution
Period
Position
Description
8. Foreign Languages:
9. Patents (if any, max. 5):
10.
ishing (if any, max. 5, the most relevant ones for the future activities of the project
infrastructure ):
Publ
11.
mber in Professional Associations:
Me
12.
er Specializations and Qualifications:
Oth
13.
Exp
erience (including managerial experience) in other national/international programmes/
projects:
Programme/Project
Position
Period
14.
arch areas and topics approached in the developed project infrastructure:
I hereby state on my own responsibility that the data presented is accurate.
Date:
20
Rese
21