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Application for
EC-funded service contract

Procurement notice: < Publication reference >

<Contract title>

Lot number and lot title: <if applicable>

One signed original and three copies of each application must be supplied. If there are several lots, a separate application (1 original and 3 copies) must be submitted for each lot.

1	SUBMITTED by

Name(s) of candidate(s)	Nationality(
Leader*
Partner 2*
Etc … *
*add / delete additional lines for partners as appropriate. Note that a sub-contractor is not considered to be a partner for the purposes of this application form. If this application is being submitted by an individual candidate, the name of the candidate should be entered as 'Leader' (and all other lines should be deleted)

(Country in which the candidate is registered

2	CONTACT PERSON (for this application)

Name
Organisation
Address
Telephone
Fax
e-mail
3	ECONOMIC AND FINANCIAL STANDING

Please provide the following financial data from your annual audited accounts. If audited figures are not yet available, please provide your latest estimates, clearly identifying estimated figures. Figures in all columns must be on the same basis to allow a direct, year-on-year comparison to be made (or, if the basis has changed, an explanation of the change must be provided as a footnote to the table).

Financial data	1997	1998	1999
Leader *	Annual turnover (EUR)
Annual operating profit (EUR)
Debt : Equity ratio
(total debt / equity)
Partner 2 *	Annual turnover (EUR)
Annual operating profit (EUR)
Debt : Equity ratio
(total debt / equity)
Etc …
* insert the name of the candidate in the first column, adding / delete additional lines for partners as appropriate. If this application is being submitted by an individual candidate, the name of the candidate should be entered as 'Leader' (and all other lines should be deleted)

4	STAFF RESOURCES

Please provide the following personnel statistics for the current year and in the two previous years.

Average manpower	1997	1998	1999
Overall	Total for fields related to this contract	Overall	Total for fields related to this contract	Overall	Total for fields related to this contract
Leader *	Permanent staff (
Other staff (
Partner 2 *	Permanent staff (
Other staff (
Etc ….
* insert the name of the candidate in the first column, adding / delete additional lines for partners as appropriate. If this application is being submitted by an individual candidate, the name of the candidate should be entered as 'Leader' (and all other lines should be deleted)

( staff directly employed by the candidate on a permanent basis (ie, under indefinite contracts)

( other staff not directly employed by the candidate on a permanent basis (ie, under fixed-term contracts)

5	FIELDS OF SPECIALISATION

Please use the table below which aims at indicating the relevant specialisms related to this contract of each candidate, by using the names of these specialisms as the row headings and the name of the candidate(s) as the column headings. Show the relevant specialism(s) of each candidate by ticking (() in the box corresponding to those specialisms in which the candidate has significant experience. [Maximum 10 specialisms]

Leader	Partner 2	Partner 3	Etc …(
Relevant specialism 1
Relevant specialism 2
Etc …(
( add / delete additional lines and/or rows as appropriate. If this application is being submitted by an individual candidate, the name of the candidate should be entered as 'Leader' (and all other columns should be deleted)

6	EXPERIENCE

Please complete a table using the format below to summarise the major relevant projects related to this contract carried out over the past 3 years by the candidate(s). The number of references to be provided must not exceed 15 for the entire application

Ref # (maximum 15)	Project title	…
<Name of candidate>	Country	Overall project value (EUR)	Proportion carried out by candidate (%)	No of staff provided	Name of client	Origin of funding	Dates (start/end)	Name of partners if any
…	…	…	…	…	…	…	…
Detailed description of project	Type of services provided
…	…

7	DECLARATION(S)

As part of their application, each candidate, including every partner of a consortium, must submit a signed declaration using the format below. [For consortia, the declaration of the Leader must be a signed original but those of other partners may be faxed copies].

[On headed notepaper]

<Date>

<Name and address of the Contracting Authority - see points 5 & 25 of the procurement notice >

Your ref: < Publication reference >

Dear Sir/Madam

In response to your procurement notice < Publication reference >, we confirm that we intend to submit a tender for [Lot n of] the above contract if we are invited to do so.

We hereby declare that we, < name of candidate >:

are making this application in our own right and [ on an individual basis ]* / [ as partner of the consortium led by < name of the leader / ourselves > ]* for this contract [Lot No]. We confirm that we are not participating in any other application for the same contract [Lot No], whatever the form of the application (as a partner - including leader - in a consortium or as a sub-contractor to any candidate);

are not in any of the situations excluding us from participating in contracts which are listed in Section 2.3 of the Manual of Instructions for External Relations Contracts (available from the following Internet address: http://europa.eu.int/comm/europeaid/index_en.htm);

agree to abide by the ethics clauses in Section 7 of the Manual of Instructions and, in particular, have no potential conflict of interests or any relation with other candidates or other parties in the tender procedure at the time of the submission of this application;

will inform the Contracting Authority immediately if there is any change in the above circumstances at any stage during the implementation of the contract; and

fully recognise and accept that any inaccurate or incomplete information deliberately provided in this application may result in our exclusion from this and other contracts funded by the European Communities.

Yours faithfully

<Signature of authorised representative of the candidate>

Name and position of authorised representative of the candidate

* Delete as applicable

Circulation restricted to the Contracting Authority and the author of the document to protect the individual and privacy and commercial and industrial secrecy - Compulsory use for service contract tenders of EUR 200,000 or more

Page 2 of 4	© European Commission 2000

1/2001	Page 1 of 4	© European Commission 2001

Page 3 of 4	© European Commission 2000

Page 4 of 4	© European Commission 2000

Se l’utente ha già scaricato l’archivio personale dal sito di EuroService, facendo doppio clik sul bottone qui a destra è possibile salvare automaticamente il presente documento nell’apposita cartella dell’Archivio Personale sul proprio computer

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2001-03-27

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