Directorate-General for Internal Policies
Directorate B – Structural and Cohesion Policies
ANNEX I
Call for Expression of Interest
IP/B/AGRI/CEI/2015-070
APPLICATION FORM
1. INFORMATION ABOUT THE APPLICANT
1.1.
Official First Name(s):
Official FAMILY NAME:
1.2.
Official Address:
Tel.:
Fax:
E-Mail:
1.3.
Nationality:
1.4.
Current Office Address:
Tel.:
Fax:
E-Mail:
1.5.
Bank Account Number:
IBAN:
BIC/SWIFT:
Name of the Bank:
Address of the Bank:
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Call for Expression of Interest
IP/B/AGRI/CEI/2015-070
2. STRUCTURE OF THE APPLICATION
The application must be structured as follows:
Required documents and information
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Check
list
A cover letter of no more than one page (max. 500 words), in which
the applicant is asked to elaborate on his/her personal incentive(s) for
applying, and to clearly indicate in which of the seven main fields of
activity of the REGI Committee (see Paragraph 1.1.) he/she would
consider himself/herself able to provide the requested forms of expertise
(multiple entries possible).
YES
A full curriculum vitae specifying knowledge of languages, academic
qualifications and background, as well as expertise and experience relevant
to this call for expression of interest. The curriculum vitae should follow the
basic structure of the Europass template, and should be set out as follows:
YES

NO

NO
1. Personal information; 2. Work experience (in the scientific/academic
field); 3. Education and training; 4. Level(s) of (foreign) language
competence; 5. Personal skills and competences (with scientific/academic
relevance); 6. Additional information pertinent to this call for expression of
interest (ongoing or planned research projects, awards received, etc.).
A full record of their publications (starting with the most recent) on
research subjects relevant to this call for expression of interest, in
particular contributions to peer-reviewed journals and monographs
accepted for publication after a similar review process by the publishing
house in question. The applicant is also asked to name the five publications
he/she deems most important, should the publication records contain more
than five entries.
YES

NO
For doctoral students and postdocs who have not authored any peerreviewed publications: confirmation of having pertinent academic teaching
experience (minimum two academic terms with one course taught per
term).
YES
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A list of remunerated projects/services carried out in the past five
years which are relevant to this call for expression of interest (if any),
clearly indicating the recipients and their contact details, sums involved,
dates and place of work.
YES
5
A description of the expert’s scientific/academic network in connection
with his/her research, for example in the form of a list of conference
presentations, consultancy projects, collaborations, membership of
research networks, think tanks or advisory groups, etc.;
Doctoral students and postdocs working in the field who have less
than six years proven professional experience must also provide
the following:
YES
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NO
NO
NO
o attestation proving their enrolment in a structured full-time doctoral
programme of at least three years (minimum requirement: second year
of doctoral studies) or their pursuit of a remunerated full-time
postdoctoral project;
o an outline (max. 1 000 words) of their doctoral thesis or postdoctoral
research project, which must explicitly deal with one of the areas
specified in Paragraph 1.1. and have a clear European focus;
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o at least two academic reference letters, at least one of which must be
provided by a tenured/full professor.
The Financial Identification Form (Annex II), duly completed and
bearing the stamp of the relevant bank and the signature of the
bank’s representative.
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
YES
NO
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Call for Expression of Interest
IP/B/AGRI/CEI/2015-070
3. DECLARATION ON THE APPLICANT’S HONOUR CONCERNING EXCLUSION
CRITERIA AND ABSENCE OF CONFLICTS OF INTEREST
I, the undersigned applicant,
Mr/Ms (First and FAMILY Name).....................................................
hereby declare on my honour that:
(a) I am not bankrupt or being wound up, am not having my affairs administered by the
courts, have not entered into an arrangement with creditors, have not suspended
business activities, am not the subject of proceedings concerning those matters, and
am not in any analogous situation arising from a similar procedure provided for in
national legislation or regulations;
(b) I have not been convicted of an offence concerning my professional conduct by a
judgement which has the force of res judicata;
(c) I have not been guilty of grave professional misconduct proven by any means which
the contracting authority can justify;
(d) I have fulfilled my obligations relating to the payment of social security contributions
and the payment of taxes in accordance with the legal provisions of the country in
which I am resident or with those of the country of the contracting authority or those of
the country where the contract is to be performed;
(e) I have not been the subject of a judgement which has the force of res judicata for
fraud, corruption, involvement in a criminal organisation or any other illegal activity
detrimental to the financial interests of the Communities/the European Union;
(f) I am not currently the subject of an administrative penalty imposed by the contracting
authority under Article 96(1) of the Financial Regulation.1
I hereby undertake to supply any documents specifically requested.
The undersigned is aware of the fact that contracts may not be awarded to
candidates or applicants who, during the procurement procedure:
(1) are subject to a conflict of interest in connection with the contract; a conflict of interest
might arise in particular as a result of economic interests, political or national affinities,
family or emotional ties, or any other relevant connection or shared interests;
(2) are guilty of misrepresentation in supplying the information required by the contracting
authority as a condition of participation in the procurement procedure or fail to supply
this information;
(3) find themselves in one of the situations of exclusion ((a) to (f) above), referred to in
Article 93(1) of the Financial Regulation, for the procurement procedure.
In addition, I, the undersigned, declare on my honour that:
 I will inform the contracting authority, without delay, of any situation considered to
be a conflict of interest or which could give rise to a conflict of interest;
 I have not granted and will not grant, have not sought and will not seek, have not
attempted and will not attempt to obtain, and have not accepted and will not accept
any advantage, either financial or in kind, to or from any party whatsoever,
constituting an illegal practice or involving corruption, either directly or indirectly, as
an incentive or reward relating to the award or the execution of the contract;
 the information provided to the European Parliament within the context of this call
for expression of interest is accurate, sincere and complete.
Place and date: .......................................... Signature: ...........................................
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The contracting authority will check in the central database whether an administrative penalty is still in force.
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4. DECLARATION OF FINANCIAL CAPACITY AND PROFESSIONAL INDEPENDENCE
The undersigned declares that:
 he/she has the economic and financial capacity to provide the services set out in
the call for expression of interest;
 he/she will fulfil his/her responsibilities in full independence of other professional
and academic commitments;
 there are no professional or financial constraints on his/her availability to carry
out the required assignments or that would compromise the impartiality of the
advice given;
 he/she will notify the European Parliament without delay if the above situation
changes, particularly in such a way as to compromise the independent nature of
the expertise to be provided.
5. DECLARATION OF ACCEPTANCE
The undersigned declares that he/she accepts all terms and conditions of all the documents
received in relation to this call for expression of interest, including those of the draft order
form.
Signed in (place) on (date): ...........................................
...........................................
Signature of the applicant
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