Proposal code:
Date received:
Acronym:
PROPOSAL ACRONYM
Proposal title
Application form
Name of the coordinating centre
Date
Proposal code:
Date received:
Acronym:
Application form for grants to support the production of prototypes and the
application and transfer of the results of research carried out in the CERCA Research
Centres of Catalonia.
1. Application.
Mr/Ms
NIE
with DNI or NIE
acting as technical supervisor of the project, and Mr/Ms
with DNI or
acting as legal representative of Coordinating centre with Spanish corporate tax ID (CIF) no.
STATE: that in regard to the call for proposals dated 16th September 2011 announced in the Institució
CERCA website (www.cerca.cat), they consider that they comply with the requirements for application, and
hereby expressly accepting all of the conditions of this call for applications,
REQUEST: the award of a grant of the sum of €
within the scope of the Prova’t projects scheme, a
funding scheme intended to support the production of prototypes and the application and transfer of the
results of research carried out in the CERCA Research Centres of Catalonia, to use in carrying out the project
entitled Proposal title . The total cost of the project is anticipated to be €
. To this effect, the parties
DECLARE:
- That the entity has not received or applied for other projects, income or resources for the same costs subject
contained in this proposal and that if they should have or obtain such resources, they undertake to notify the
CERCA Institute of this as soon as possible.
- That the entity complies with the requirements set out in Articles 32.1, 32.3 and 36.4 of Law 1/1998, of 7
January, on language policy.
- That the entity complies with the minimum quota for the social integration of people with disabilities, which is
2% for entities with more than 50 employees (Law 13/1982 of 7 April) or applies the alternative measures
(Royal Decree 364/2005 of 8 April).
- That none of the situations laid out in Article 13 of the General Subsidies Act, Law 38/2003 of 17 November,
applies to the entity and that the latter complies with the obligations set out in Articles 90 bis and 92.2 of the
revised text of the Catalan Public Finance Law.
Proposal code:
Date received:
Acronym:
- That the entity has not been sanctioned by a final ruling for serious offences in matters of the workplace
integration of people with disabilities or very serious offences in social matters or in matters of workplace
health and safety.
- That the entity has no debts for any amount to the Spanish government or the Government of Catalonia or
its autonomous bodies and that it is up to date with tax and social security payments.
- That the entity complies with Law 5/2008 of 24 April on the right of women to eradicate sexist violence, for
entities with a staff of 25 people or more.
- That the entity accepts the use of e-mail as the preferential medium for the receipt of all notifications related
to this call for applications.
- That the entity accepts all of the terms and conditions of the call for applications and that the information
entered in the application form and the attached documentation is correct.
Location, Date
Project Supervisor
Legal Representative (stamp and signature)
Proposal code:
Date received:
Acronym:
2. General information for the coordinating CERCA centre.
Centre:
Acronym:
Project supervisor / coordinator:
Corporate tax ID (CIF) no.:
Telephone:
Contact e-mail address:
General information for other participating CERCA centres.
Add as many tables as participants the project has.
Name:
Project supervisor:
Acronym:
Corporate tax ID (CIF) no.:
Telephone:
Contact e-mail address:
Legal representative:
Telephone (direct line):
Contact e-mail address:
ID card (DNI) no.:
Signature and stamp (*)
Date:
(*) The signature of the legal representative implies the acceptance by each entity of all of the terms and
conditions for the call for applications, compliance with all of the legal requirements for the entity making
the application, the authorisation of the technical supervisor to act as representative of the entity making
the application and the confirmation of the accuracy of the data and documentation attached to the
application form.
Proposal code:
Date received:
Acronym:
Name:
Project supervisor:
Acronym:
Corporate tax ID (CIF) no.:
Telephone:
Contact e-mail address:
Legal representative:
Telephone (direct line):
Contact e-mail address:
ID card (DNI) no.:
Signature and stamp (*)
Date:
Name:
Project supervisor:
Acronym:
Corporate tax ID (CIF) no.:
Telephone:
Contact e-mail address:
Legal representative:
Telephone (direct line):
Contact e-mail address:
ID card (DNI) no.:
Signature and stamp (*)
Date:
Proposal code:
Date received:
Acronym:
3. General information on the proposal.
Proposal title:
Acronym:
Type of project:
Key words:
Knowledge area:
Target market:
Start date:
End date:
Length (months): 0
Basic, non-confidential description (max. 1500 characters)
In line with Organic Law 15/1999, of 13 September, on personal data protection and Royal Decree 1720/2001,
of 21 December, approving the regulation implementing this Law, you are hereby informed that the data
provided will be incorporated into an electronic file that is owned by the CERCA Institute for the exclusive
purpose of managing the relevant application.
Proposal code:
Date received:
Acronym:
4. Budget and sources of funding.
Budget by items.
Total budget (€):
Item
Total cost (€):
Subsidy (€)
Staff costs (eligible, contracted employees)
0,00 €
0,00 €
Materials and equipment procurement costs
0,00 €
0,00 €
Travel and accommodation costs
0,00 €
0,00 €
Costs for subcontracting services (*)
0,00 €
0,00 €
General costs related to the proposal
0,00 €
0,00 €
(*) Any agent or entity that is not part of the CERCA system may only participate in the project as a
subcontractor.
Budget by entities.
Total budget (€):
Total cost (€):
Item
C
P1
P2
Staff costs (eligible, contracted employees)
0,00 €
0,00 €
0,00 €
Materials and equipment procurement costs
0,00 €
0,00 €
0,00 €
Travel and accommodation costs
0,00 €
0,00 €
0,00 €
Costs for subcontracting services (*)
0,00 €
0,00 €
0,00 €
General costs related to the proposal
0,00 €
0,00 €
0,00 €
(C) Coordinating CERCA centre / (P) Participating CERCA centres.
Proposal code:
Date received:
Acronym:
Budget by work packages.
Total budget (€):
Description
Entity (acronym)
Total cost (€):
WP1
0,00 €
WP2
0,00 €
WP3
0,00 €
WP4
0,00 €
WP5
0,00 €
WP6
0,00 €
WP7
0,00 €
WP8
0,00 €
Sources of funding associated with the proposal
Entity
Funding (€)
Percentage (+)
0,00 €
0,00%
0,00 €
0,00%
0,00 €
0,00%
(+) The percentage of funding should be expressed in terms of the total cost of the project.
Proposal code:
Date received:
Acronym:
Annex
Use this space in case you need to expand any of the tables.
In any case, please, use the same format.