Application Form for the Sub-Loan Application within MUNSEFF
1. THE INFORMATION ABOUT PROJECT SUB-BORROWER
Name of Applicant:
..........................................................................……………………………………….
Legal Status: ………………………………..……………………………………….
ID Number:……………………………………………………………………………
Contact Person: …………………………….………………………...…………….
Address:……………………………………….…………………………………….…
………………………………………………...……………………………………….
Tel.:…………………………………………..
Fax:…………………………………………..
E-mail:……………………………………….
2. SELECTION OF PARTICIPATING BANK
Slovenská sporiteľňa, a.s.
3. DID YOU ALREADY DISCUSS YOUR INVESTMENT PLAN?
Yes
If Yes, Please Specify Contact Person: ………………………………………….…..
No
Date of Discussion: ……………………………………………………………………
SUB-PROJECT DETAILS
1. PROJECT LOCATION:
…………………………………………………………………………………………
2. PROJECT CATEGORY:
Please thick the project category
Component 1 - Municipal infrastructure energy efficiency Sub-projects
Component 2 - Municipal building Sub-projects
3. Expected total investment cost:
4. Expected amount of required sub-loan:
5. Expected Annual Benefits (energy savings,
energy from RES), energy costs
……………. thous. EUR 100 %
…………….thous. EUR ……%
Percentage of actual energy
consumption, energy costs
…………………GJ (heat, fuel)
………………………%
…………………kWh (electricity)
………………………%
…………………thous. EUR(total)
………………………%
6. Other financial benefits and maintenance cost savings achievable by Project
realization
..........................thous. EUR
7. Expected beginning of investment
…..../…....(month/year)
8. Expected period of investment
…………..months
9. Intended Energy Saving Measures (Please, thick):
Component 1 - Municipal infrastructure
Component 2 - Municipal buildings
Co-generation or tri-generation of heat,
electricity and cool
Stairway (common) windows and/or
glass walls replacement
Flat windows and balcony doors
replacement
Entrance doors replacement
Walls insulation
Roof insulation
Basement ceiling insulation
Inner walls insulation
Replacement of existing boilers with
more efficient ones or due to fuel switching
Installation of efficient boilers, microcogeneration
Boiler room reconstruction
Fuel switching
Rehabilitation of boilers
Rehabilitation of heat distribution
systems including implementation of heat
control and measurement measures
Replacement of oversized electrical
motors, installation of Variable Speed Drives
on electric motors
Installation/reconstruction of heat
transfer stations
Balancing of heat systems
Individual heat consumption control
systems
Rehabilitation of power distribution
systems
Installation of new radiators
Implementation of Energy Management
Systems
Urban renewable energy systems
Rehabilitation of street lighting
Other, please describe …
Comments:
Other, please describe …