LIFE+    Nature & Biodiversity
TECHNICAL APPLICATION FORMS
Part A – administrative information

LIFE+ Nature & Biodiversity 2009- A1

		LIFE+ 2009
			
				for ADMINISTRATION use only

	

		
							
				LIFE+ 09 NAT/

PROJECT

Project title (max. 120 characters):
.....................................................................................................................................................................
Project acronym (max. 25 characters): …………………………………………..……..……..……..……..……
The project will be implemented in the following:
Country(ies) ………………………………………………………………………………………………………….
Administrative region(s)……………………………………………………………………………………………..
Expected start date: …………………………		 Expected end date: ……………………………..
BeneficiarIES

Name of the coordinating beneficiary (1): ..................................................................................................
Name of the associated beneficiary (2): ………………………………………………………………………...
Name of the associated beneficiary (3): …………………………………………………………………………
Name of the associated beneficiary (4): …………………………………………………………………………
(Continue as necessary)
Project Budget and REQuested EC funding
Total project budget:  			……………. €
Total eligible project budget:  		……………. €
EC financial contribution requested: 	……………. €   ( = …….. % of total eligible budget)

PROJECT POLICY AREA 

You can only tick one of the following options: 
LIFE+ Nature: Best practice and/or demonstration project contributing to the implementation of the objectives of the EU Birds and Habitats Directives (Council Directives 79/409 EEC and 92/43/EEC)		

	
LIFE+ Biodiversity:  Demonstration and/or innovative project contributing to the objectives of the Commission Communication COM (2006) 216 final: "Halting the loss of Biodiversity by 2010 – and beyond"		

LIFE+ Nature & Biodiversity 2009- A2

	Coordinating Beneficiary Profile Information 	
Short Name 		Beneficiary n°	1	
Legal information on the Coordinating Beneficiary	
Legal Name 		Legal Status	
VAT No		Public body
Private commercial
Private non- commercial			
Legal Registration No					
Registration Date					
Legal address of the  Coordinating Beneficiary	
Street Name and No		PO Box 		
Post Code 		Town/City		
Country Code 		Country Name 		
Coordinating Beneficiary contact person information	
Title  		Function		
Surname		First Name		
E-mail address		
Department / Service		
Street Name and No		PO Box		
Post Code		Town/City		
Country		
Telephone No		Fax No		
Coordinating Beneficiary details	
Year 			
Annual turnover 		Annual Balance Sheet Total 		
Number of employees		
Website		
	
Brief description of the Coordinating Beneficiary's activities and experience in the area of the proposal 	

	
YOU MAY NOT DUPLICATE THIS PAGE

LIFE+ Nature & Biodiversity 2009- A3

COORDINATING BENEFICIARY DECLARATION 

The undersigned hereby certifies that:

1.	The specific actions listed in this proposal do not and will not receive aid from the Structural Funds or other Community financial instruments. In the event that any such funding will be made available after the submission of the proposal or during the implementation of the project, my organisation will immediately inform the European Commission.

2.	My organisation (add name) …………………………………………………….. has not been served with bankruptcy orders, nor has it received a formal summons from creditors.  My organisation is not in any of the situations listed in Articles 93.1 and 94 of Council Regulation 1605/2002 of 25/06/2002 (OJ L248 of 16/09/2002).

3.	My organisation (which is legally registered in the European Union) will contribute (add amount) …………………… €  to the project.  My organisation will participate in the implementation of the following actions (add action code(s)): ……………………… .  The estimated total cost of my organisation's part in the implementation of the project is (add amount) …………………… €.

4.	Should one or more associated beneficiary or co-financier reduce or withdraw its financial contribution, my organisation will ensure that a corresponding additional contribution is made available.

5.	My organisation will conclude with the associated beneficiaries and co-financiers any agreements necessary for the completion of the work, provided these do not infringe on their obligations, as stated in the grant agreement with the European Commission. Such agreements will be based on the model proposed by the European Commission. They will describe clearly the tasks to be performed by each associated beneficiary and define the financial arrangements.

6.	I am aware that my organisation is solely legally and financially responsible to the Commission for the implementation of the project (Article 4 of the Common Provisions).

I am legally authorised to sign this statement on behalf of my organisation.  

I have read in full the Common Provisions (attached to the Model Grant Agreement provided with the LIFE+ application files).

I certify to the best of my knowledge that the statements made in this proposal are true and the information provided is correct.

At ................................................. on........................................................

Signature of the Coordinating Beneficiary:

Name(s) and status of signatory: .........................................................................................

LIFE+ Nature & Biodiversity 2009- A4

ASSOCIATED BENEFICIARY DECLARATION (complete for each Associated Beneficiary)

The undersigned hereby certifies that:
1.	My organisation (add name) …………………………………………………….. has not been served with bankruptcy orders, nor has it received a formal summons from creditors.  My organisation is not in any of the situations listed in Articles 93.1 and 94 of Council Regulation 1605/2002 of 25/06/2002 (OJ L248 of 16/09/2002).
2.	My organisation (which is legally registered in the European Union) will contribute (add amount) …………………… €  to the project.  My organisation will participate in the implementation of the following actions (add action code(s)): ……………………… .  The estimated total cost of my organisation's part in the implementation of the project is (add amount) …………………… €.
3.	My organisation will conclude with the coordinating beneficiary an agreement necessary for the completion of the work, provided this does not infringe on our obligations, as stated in the grant agreement with the European Commission. This agreement will be based on the model proposed by the European Commission. It will describe clearly the tasks to be performed by my organisation and define the financial arrangements.
4.	For the purposes of the implementation of the agreement regarding this project between the European Commission and the coordinating beneficiary: 
a) My organisation grants power of attorney to the coordinating beneficiary, to act in our name and for our account in signing the above-mentioned agreement and its possible subsequent riders with the European Commission. Accordingly, my organisation hereby mandates the coordinating beneficiary to take full legal responsibility for the implementation of such an agreement. 
b) My organisation hereby confirms that we have taken careful note of and accept all the provisions of the above agreement with the European Commission, in particular all provisions affecting my organisation and the coordinating beneficiary. In particular, my organisation acknowledges that, by virtue of this mandate, the co-ordinator alone is entitled to receive funds from the Commission and distribute to my organisation the amount corresponding to our participation in the action.
c) My organisation hereby agrees to do everything in our power to help the coordinating beneficiary fulfil his obligations under the above agreement. In particular, my organisation hereby agrees to provide him whatever documents or information may be required, as soon as possible after receiving his request.
d) The provisions of the above agreement, including this mandate, shall take precedence over any other agreement between my organisation and the coordinating beneficiary which may have an effect on the implementation of the above agreement between the coordinating beneficiary and the Commission.

I am legally authorised to sign this statement on behalf of my organisation.  
I have read in full the Common Provisions (attached to the Model Grant Agreement provided with the LIFE+ application files).
I certify to the best of my knowledge that the statements made in this proposal are true and the information provided is correct.
At ................................................. on........................................................
Signature of the Associated Beneficiary:
Name(s) and status of signatory: ...............................................................................................

	LIFE+ Nature & Biodiversity 2009- A5

ASSOCIATED BENEFICIARY PROFILE (complete for each Associated Beneficiary)

Associated Beneficiary profile information	
  Short name		  Beneficiary n°		
Legal information on the Associated Beneficiary	
Legal Name 		Legal Status	
VAT No		Public body
Private commercial
Private non-commercial			
Legal Registration No					
Registration Date					
Legal address of the Associated Beneficiary	
Street Name and No		PO Box 		
Post Code 		Town/City		
Country Code 		Country Name 		

Brief description of the Associated Beneficiary's activities and experience in the area of the proposal	

YOU MAY DUPLICATE THIS PAGE

LIFE+ Nature & Biodiversity 2009- A6

CO-FINANCIER PROFILE AND COMMITMENT FORM (Complete for each co-financier)

Legal Name and full address on the co-financier	
	
Financial commitment 	
We will contribute the following amount to the project:	….. Euro	
Status of the financial commitment	
	
Signature of the authorised person	
Name and status of the authorised person (obligatory):		
Date of the signature
(obligatory):		
Authorised signature (obligatory):		

YOU MAY DUPLICATE THIS PAGE

LIFE+ Nature & Biodiversity 2009- A7

OTHER PROPOSALS SUBMITTED FOR COMMUNITY FUNDING

Please answer each of the following questions :

•	Have you or any of your associated beneficiaries already benefited from previous LIFE co-financing? (please cite LIFE project reference number, title, year, amount of the co-financing, duration, name(s) of coordinating beneficiary and/or partners involved):

•	Have you or any of the associated beneficiaries submitted any actions related directly or indirectly to this project to other Community financial instruments? To whom? When and with what results?

•	For those actions which fall within the eligibility criteria for financing through other Community financial instruments, please explain in full detail why you consider that those actions nevertheless do not fall within the main scope of the instrument(s) in question and are therefore included in the current project. 

	

LIFE+ Nature & Biodiversity 2009- A8

DECLARATION OF SUPPORT FROM THE COMPETENT AUTHORITY 
This form is mandatory for all LIFE+ Nature and LIFE+ Biodiversity project proposals. For transnational project proposals, a separate copy must be filled in by the competent nature conservation / biodiversity authority of all participating countries.

Optional: this form may also be used to indicate any other support to the project by important stakeholder bodies, administrative bodies or individuals that may be concerned by the project.

Name and legal status: 

Full address: 

Tel: ..................................     Fax: ..................................   E-mail: 

Contact person (name and function): 

Please specify whether, why and how you will support this project: 

Signature and date:

Name and status of signatory:

YOU MAY DUPLICATE THIS PAGE

LIFE +    Nature and Biodiversity
TECHNICAL APPLICATION FORMS
Part B – technical summary and overall context of the project 

LIFE+ Nature & Biodiversity 2009- B1

SUMMARY DESCRIPTION OF THE PROJECT (Max. 3 pages; to be completed in English)

Project title: ......................................................................................................................................................................................................................................................................................................................................................................................................

Project objectives:

Actions and means involved:

Expected results (outputs and quantified achievements):

Can the project be considered to be a climate change adaptation project?		Yes	□
											No	□

LIFE+ Nature & Biodiversity 2009- B2a
GENERAL DESCRIPTION OF THE AREA / SITE(S) TARGETED BY THE PROJECT

Name of the project area: .....................................................................................................

Surface area (ha): .........................................................................................
EU protection status:	SPA □	NATURA 2000 Code : ................................
	pSCI □	NATURA 2000 Code : ................................

Other protection status according to national or regional legislation: 

Main land uses and ownership status of the project area: 

Scientific description of project area: 

Importance of the project area for biodiversity and/or for the conservation of the species / habitat types targeted at regional, national and EU level (give quantitative information if possible):

If your project involves several distinct sub-sites, please fill in one form for each sub-site

	LIFE+ Nature & Biodiversity 2009- B2b

 MAP OF THE GENERAL LOCATION OF THE PROJECT AREA
 (Please indicate the scale of the map)

	________________

	LOCATION
	IN THE COUNTRY
	________________

LOCATION IN
THE REGION

This map must be provided in an A4 format

	LIFE+ Nature & Biodiversity 2009- B2c

Description of species / habitats / Biodiversity issues 
targeted BY THE PROJECT

	LIFE+ Nature & Biodiversity 2009- B2d

Conservation / BIODIVERSITY problemS and threats 

Please provide this information for those species and habitat types directly targeted by the project

PREVIOUS CONSERVATION EFFORTS IN THE PROJECT AREA
AND/OR FOR THE HABITATS / SPECIES TARGETED BY THE PROJECT

	LIFE+ Nature & Biodiversity 2009- B3
EU added value of the PROject and its actions

BEST PRACTICE / INNOVATION / demonstration character of the project
LIFE+ Nature projects must complete best practice and/or demonstration
LIFE+ Biodiversity projects must complete demonstration and/or innovation

BEST PRACTICE: 

DEMONSTRATION: 

INNOVATION: 

efforts for reducing the project's "carbon footprint"

	LIFE+ Nature & Biodiversity 2009- B4
EXPECTED CONSTRAINTS and risks related to the project implementation and how they will be dealt with (contingency planning)

LIFE+ Nature & Biodiversity 2009- B5

CONTINUATION / VALORISATION OF THE PROJECT RESULTS 
AFTER THE END OF THE PROJECT

•	Which actions will have to be carried out or continued after the end of the project?

•	How will this be achieved, what resources will be necessary to carry out these actions?

•	Protection status under national/local law of sites/species/habitats targeted (if relevant)

•	How, where and by whom will the equipment acquired be used after the end of the project?

•	To what extent will the results and lessons of the project be actively disseminated after the end of the project to those persons and/or organisations that could best make use of them (please identify these persons/organisations)?

LIFE +    Nature and Biodiversity
TECHNICAL APPLICATION FORMS
Part C – detailed technical description of the proposed actions 

Important note: 

•	All calculations and detailed cost breakdowns necessary to justify the cost of each action should be included in the financial forms F. In order to avoid repeating the financial information (with the risk of introducing incoherencies), Part C should only contain financial information not contained in the financial forms (e.g. details explaining the cost per hectare).   
•	All forms in this section may be duplicated, so as to include all essential information.
•	Each action described should have a clear indication of its physical target (e.g., action 1 will take place in area "X" and/or will target species "Y"). Whenever this is relevant, the location of these actions should also be identified on one or several maps which must be provided in annex (preferably one map per site). Where feasible, a map of each site should be provided that indicates the location of all the actions taking place on that site.    
•	Any action that is sub-contracted should be just as clearly described as an action that will be directly carried out by the beneficiaries.

LIFE+ Nature & Biodiversity 2009- C1a

DETAILS OF PROPOSED ACTIONS

A.	Preparatory actions, elaboration of management plans and/or of action plans

	For each action or set of actions specify the following:

	ACTION A.1: name of the action

	Description (what, how, where and when):

	Reasons why this action is necessary:

	Beneficiary responsible for implementation:

	Expected results (quantitative information when possible):

	ACTION A.2: etc…

	LIFE+ Nature & Biodiversity 2009- C1b

B.	Purchase/lease of land and/or compensation payments for use rights

For each action or set of actions specify the following:

	ACTION B.1: name of the action

	Description (what, how, where and when):

	Reasons why this action is necessary:

	Beneficiary responsible for implementation:

	Expected results (quantitative information needed):

	ACTION .B.2: etc…

	LIFE+ Nature & Biodiversity 2009- C1c

C.	Concrete conservation actions 

For each action or set of actions specify the following:

	ACTION C.1: name of the action

	Description (what, how, where and when):

Reasons why this action is necessary (specify the species / habitat(s) / biodiversity issue(s) targeted):

	Beneficiary responsible for implementation:

	Expected results (quantitative information when possible):

	ACTION C.2: etc…

	LIFE+ Nature & Biodiversity 2009- C1d

D.	Public awareness and dissemination of results

For each action or set of actions specify the following:

	ACTION D.1:  name of the action

	Description (what, how, where and when):

	Reasons why this action is necessary (specify the target audience):

	Beneficiary responsible for implementation:

	Expected results (quantitative information when possible)

ACTION D.2: etc…

	LIFE+ Nature & Biodiversity 2009- C1e

E.	Overall project operation and monitoring

For each action or set of actions specify the following:

	ACTION E.1:

Name of action:

	Description (what, how, where and when):

	Reasons why this action is necessary:

	Beneficiary responsible for implementation:

	Expected results (quantitative information when possible):

	ACTION E.2: etc…

	LIFE+ Nature & Biodiversity 2009- C2
DELIVERABLE PRODUCTS OF THE PROJECT
Name of the Deliverable	Code of the associated action	Deadline	

			

MILESTONES OF THE PROJECT
Name of the Milestone	Code of the associated action	Deadline	

			

ACTIVITY REPORTS FORESEEN
Please indicate the deadlines for the following reports: 
•	Inception Report (to be delivered within 9 months after the project start); 
•	Progress Reports n°1, n°2 etc. (if any; to ensure that the delay between consecutive reports does not exceed 18 months); 
•	Mid-term Report with payment request (only for project longer than 24 months)
•	Final Report with payment request

Type of report	Deadline	

		

	LIFE+ Nature & Biodiversity 2009- C3

TIMETABLE

List all actions ordered by number and using their numbers or names. Tick as appropriate.
(Remember that projects cannot start prior to the date of the signature of the grant agreement)

Action	2010	2011	2012	etc.	
Number/name	September	IV	I	II	III	IV	I	II	III	IV	I	II	III	IV	
A. Preparatory actions, elaboration of management plans and/or action plans :	

															

B. Purchase/lease of land and/or rights :	

															

C. Concrete conservation actions :	

															

D. Public awareness and dissemination of results :	

															

E. Overall project operation and monitoring:	

															

LIFE +    Nature and Biodiversity
TECHNICAL APPLICATION FORMS
Part D – Output indicator forms

Important note: 

•	The purpose of the D forms is to collect information for statistical purposes only (for the evaluation of the achievements of a project the EC will use the information contained in forms A, B and C). However, applicants should ensure that the information entered in the D forms corresponds as far as possible to the project outputs defined in proposal forms A, B and C.
•	Only forms D1, D2, D5, D6 and D7 should be completed for Nature proposals, and only forms D3, D4, D5, D6 and D7 for Biodiversity proposals.
•	The forms in this section may not be duplicated.

			LIFE+ Nature & Biodiversity 2009- D1

LIFE+ Nature output indicators	

OUTPUTS 	 	 	 	 	 	 	 	 	
Part 1 - Preparatory actions									
Table 1 - Types of preparatory actions planned (A, B actions)	 	 	 						
Types of preparatory actions	No. of preparatory actions	Species involved
(Latin name)	Type of habitats *	No. of species involved	No. of habitats involved	No. of N2000 sites involved	Surface involved (ha)	Budgeted cost (€)	
Plans of project measures	 	 	 	 	 	 	 	 	
Action plans	 	 	 	 	 	 	 	 	
Management plans	 	 	 	 	 	 	 	 	
Guidelines	 	 	 	 	 	 	 	 	
Inventories & Studies	 	 	 	 	 	 	 	 	
Ex ante monitoring	 	 	 	 	 	 	 	 	
Ex post monitoring	 	 	 	 	 	 	 	 	
Permit procedures	 	 	 	 	 	 	 	 	
New Natura 2000 area 	 	 	 	 	 	 	 	 	
Land purchased	 	 	 	 	 	 	 	 	
Other (please specify)	 	 	 	 	 	 	 	 	
Total	 	N/A	N/A	 	 	 	 	 	
* Identification number and name as in the Directives

			LIFE+ Nature & Biodiversity 2009- D2

OUTPUTS 	
Part 2 - Concrete actions									
Table 2 - Best practices/concrete techniques//conservation actions/methods planned (C actions)	 	 	 	 	 				
Deliverable	No. of preparatory actions	Species involved
(Latin name)	Type of habitats *	No. of species involved	No. of habitats involved	No. of N2000 sites involved	Surface involved (ha)	Budgeted cost (€)	
Natura 2000 site creation	 	 	 	 	 	 	 	 	
Natura 2000 site restoration/improvement	 	 	 	 	 	 	 	 	
Conservation actions	 	 	 	 	 	 	 	 	
Reintroduction	 	 	 	 	 	 	 	 	
Ex situ conservation	 	 	 	 	 	 	 	 	
Removal of alien species	 	 	 	 	 	 	 	 	
Others (please specify)	 	 	 	 	 	 	 	 	
Total 	 	N/A	N/A	 	 	 	 	 	
* Identification number and name as in the Directives

Table 3 - Training activities	 	 	
No. of training sessions	Total no. of persons trained	Budgeted cost (€)	

			LIFE+ Nature & Biodiversity 2009- D3

LIFE+ Biodiversity output indicators	

OUTPUTS 	
Part 1 - Preparatory actions									
Table 1 - Types of preparatory actions planned (A, B actions)						
Types of preparatory actions	No. of preparatory actions	Species involved
(Latin name)	Type of habitats *	No. of species involved	No. of habitats involved	No. of sites involved	Surface involved (ha)	Budgeted cost (€)	
Plans of project measures	 	 	 	 	 	 	 	 	
Action plans	 	 	 	 	 	 	 	 	
Management plans	 	 	 	 	 	 	 	 	
Guidelines	 	 	 	 	 	 	 	 	
Inventories & Studies	 	 	 	 	 	 	 	 	
Ex ante monitoring	 	 	 	 	 	 	 	 	
Ex post monitoring	 	 	 	 	 	 	 	 	
Permit procedures	 	 	 	 	 	 	 	 	
Other (please specify)	 	 	 	 	 	 	 	 	
Total	 	N/A	N/A	 	 	 	 	 	
* Identification number and name as in the Directives or the commonly accepted name

			LIFE+ Nature & Biodiversity 2009- D4

OUTPUTS 	
Part 2 - Concrete actions						
Table 2 - Best practices/concrete techniques//conservation actions/methods planned (C actions)				
Deliverable	No. of preparatory actions	Species involved
(Latin name)	Type of habitats *	No. of species involved	No. of habitats involved	No. of sites involved	Surface involved (ha)	Budgeted cost (€)	
Enlargement of habitats	 	 	 	 	 	 	 	 	
Site restoration/improvement	 	 	 	 	 	 	 	 	
Conservation actions	 	 	 	 	 	 	 	 	
Reintroduction	 	 	 	 	 	 	 	 	
Ex situ conservation	 	 	 	 	 	 	 	 	
Removal of alien species	 	 	 	 	 	 	 	 	
Others	 	 	 	 	 	 	 	 	
Total 	 	N/A	N/A	 	 	 	 	 	
* Identification number and name as in the Directives or the commonly accepted name

Table 3 - Training activities	 	 	
No. of training sessions	Total no. of persons trained	Budgeted cost (€)	

			LIFE+ Nature & Biodiversity 2009- D5

OUTPUTS	 	 	 	 	 	 	 	 	 	
Part 3 – Awareness-raising and communication										
Table 4 - Workshops, seminars and conferences										
Target audience:	General public	Specialised audience (e.g. decision-makers)	Very specialised audience (e.g. experts, academics)	
Number of participants:	Local/ Regional	National	EU/ International	Local/ Regional	National	EU/ International	Local/ Regional	National	EU/ International	
0-25 participants	 	 	 	 	 	 	 	 	 	
25-75 participants	 	 	 	 	 	 	 	 	 	
75-100 participants	 	 	 	 	 	 	 	 	 	
More than 100 participants	 	 	 	 	 	 	 	 	 	
Total budgeted cost (€)	 									

			LIFE+ Nature & Biodiversity 2009- D6

Table 5 - Media and other communication and dissemination work			Table 6 - Publications				
Type of media	No.		Type of publication	No. published	No. of copies	Languages	
Project website: average number of visitors per month	 		Layman's report	 	 	 	
Press releases made by the project	 		Manuals	 	 	 	
General public article in national press	 		Leaflets	 	 	 	
General public article in local press	 		Brochures	 	 	 	
Specialised press article	 		Posters	 	 	 	
Internet article	 		Books	 	 	 	
TV news/reportage	 		Technical publications	 	 	 	
Radio news/reportage	 		Other (please specify)	 	 	 	
Film produced	 		Total budgeted cost (€)	 			
Film played on TV	 								
Film presented in events/festivals	 								
Exhibitions attended	 								
Information centre/Information kiosk	 								
Project notice boards	 								
Other (please specify)	 								
Total budgeted cost (€)	 								

			LIFE+ Nature & Biodiversity 2009- D7

Table 7 - Educational activities		
Establishment involved	No. of students	
Kindergartens/Primary schools	 	
Secondary schools	 	
Higher education establishments	 	
Total budgeted cost (€)