Proposal Submission Forms EUROPEAN COMMISSION TRANS EUROPEAN TRANSPORT NETWORK by epmd

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									                                Proposal Submission Forms
                     EUROPEAN COMMISSION         TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                    A1
 Proposal Nr.

 Multi-Annual Programme 2007-2013
 Annual Programme

                                GENERAL INFORMATION ON THE PROPOSAL

 Title of the proposed action

 Priority/Horizontal project                         ▼ Section (only for PP)         ▼
 Transport mode                                                                      ▼
 Start date of the Action                            End date of the Action
                                     Summary (up to 2000 characters)




                                                Proposal field

Please enter the proposal field:

 Proposal field:

                                                Proposal type

Please ‘tick’ the box with the proposal type:

 Study
 Work

For ERTMS proposals only:

 Trackside infrastructure
 On board equipment
                                  Proposal Submission Forms
                     EUROPEAN COMMISSION         TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                           A2.1
 Proposal Nr.                                             Applicant Nr

                                     INFORMATION ON ORGANISATIONS

 Organisation legal name

                                            Administrative data

 Legal address
 Street name                                                                 Number

 Town / City
 Postal Code / Cedex
 Country

                                        Legal status of the applicant

Please ‘tick’ the box with the legal status of the applicant.

 Member State
 Public Undertaking or Body
 Private Undertaking or Body
 International Organisation (*)
 Joint Undertaking (*)

(*)Please attach the letter(s) containing the approval of the Member State(s) concerned.

For multi-beneficiary proposals only.

 Coordinating applicant




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                            Proposal Submission Forms
                  EUROPEAN COMMISSION         TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                 A2.2
Proposal Nr.                                         Applicant Nr

                                            Contact points

Contact person
Family Name                                           First name(s)
Function
Is the address different from the legal address?                        YES/NO
Street name                                                           Number

Town / City
Postal code / Cedex
Country
Phone
Fax
E-mail

Authorised representative to sign this application
Family Name                                           First name(s)
Function
Is the address different from the legal address?                      YES/NO
Street name                                                           Number

Town / City
Postal code / Cedex
Country
Phone
Fax
E-mail

Date
                               Proposal Submission Forms
                    EUROPEAN COMMISSION           TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                                  A2.3
 Proposal Nr.                                             Applicant Nr

                                          FINANCIAL IDENTIFICATION

                                               Account holder

 Family name (1)                                            First name(s)
 Street name                                                                      Number

 Town / City
 Postal code / Cedex
 Country

                                               Contact person

 Family name                                                First name(s)
 Phone
 Fax
 E-mail

                                                     Bank

 Bank Name
 Branch address
 Street name                                                                      Number

 Town / City
 Postal code / Cedex
 Country

 Account number
 IBAN (2)

(1) The name or title under which the account has been opened and not the name of the authorized agent.
(2) If the IBAN Code (International Bank account number) is applied in the country where your bank is situated.
                               Proposal Submission Forms
                    EUROPEAN COMMISSION           TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                        A2.4
 Proposal Nr.                                             Applicant Nr

                 IF YOUR ORGANISATION IS A MEMBER STATE, INTRODUCE BELOW THE
          PUBLIC OR PRIVATE UNDERTAKING OR BODY(IES) WHICH WILL IMPLEMENT THE ACTION

 Organisation legal name

                                             Administrative data

 Legal address
 Street name                                                                   Number

 Town / City
 Postal code / Cedex
 Country

(*) If there are more than one implementing body, please introduce them all.

    IF YOUR ORGANISATION IS A PUBLIC OR PRIVATE UNDERTAKING OR BODY, INTRODUCE BELOW THE
                           MEMBER STATE APPROVING THIS APPLICATION

 Ministry legal name

                                             Administrative data

 Legal address
 Street name                                                                   Number

 Town / City
 Postal code / Cedex
 Country

 Authorised representative to sign this application
 Family name                                                First name(s)
 Function
 Is the address different from the legal address?                              YES/NO
 Street name                                                                   Number

 Town / City
 Postal code / Cedex
 Country
 Phone
 Fax
 E-mail

 Date
                                    Proposal Submission Forms
                       EUROPEAN COMMISSION              TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                                     A3.1
 Proposal Nr.

                                                 LOCATION OF THE ACTION

 Member State(s)                                    ▼                 ▼         ▼               ▼                ▼
 Region(s) (1)                                      ▼                 ▼         ▼               ▼                ▼

(1) Regions will be given following NUTS 2 nomenclature.

                                                Geographical co-ordinates

                                 Long (X) (2)           Lat (Y) (2)
 Start point
 Interim point 1
 Interim point 2
 …
 Interim point n
 End point

(2) Long & lat must be given in a seven digit number (+ or - sign followed by three digits and by four decimals).

                                                ACTIVITIES OF THE ACTION

 Activity      ISIC                               Activity name                     Start     End        Verifying
 number      code (3)                                                               date      date       milestone
                    ▼
                    ▼
                    ▼
                    ▼

(3) For complete description and other codes, see: http://unstats.un.org/unsd/cr/registry/regcst.asp?Cl=17

                                                MILESTONES OF THE ACTION

 Milestone                             Milestone name                           Expected    Means of verification
  number           (including milestones at start and end date of the Action)     date




                       CONTRIBUTION OF THE ACTION TO THE TEN-T POLICY OBJECTIVES

If the Action is part of a Global Project previously supported under the TEN-T budget, please specify:

 Decision number         Title
                                  Proposal Submission Forms
                      EUROPEAN COMMISSION             TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                            A3.2
 Proposal Nr.

                                             FINANCIAL INFORMATION

                                                     Global project

 SOURCES OF FINANCING                         Contribution
 1. State budget (-s)
 2. Regional/local budget
 3. Project promoter (Public or Private)
 4. EIB loan
 5. Other loans
 6. TEN financing
 7. Other EU funds (ERDF, CF, FPR)
 8. Other sources
 Total

For multi-beneficiary projects, please give only the total amounts per category.

                                                 Proposed Action

 SOURCES OF FINANCING                   (*) Total      2008    2009   2010   2011   2012   2013   >2013
                                       proposed
                                      contribution
 1. State budget(s)
 2. Regional/local budget(s)
 3. Action promoter
 (Public or Private)
 4. EIB loan
 5. Other loans
 6. TEN financing
 7. Other EU funds
 8. Other sources
 Total

(*) Contribution to eligible costs only.

For multi-beneficiary actions, please split state and regional budgets by applicant.
                                                           Proposal Submission Forms
                     EUROPEAN COMMISSION                                     TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                                                                                         A3.3
 Proposal Nr.

                                 INDICATIVE BREAKDOWN OF ESTIMATED ELIGIBLE COSTS OF THE PROPOSED ACTION BY ACTIVITIES

             Activities                  2008            2009             2010            2011            2012             2013            >2013        Total eligible
                                                                                                                                                            cost
 1.DIRECT COST
 1.1 Activity 1
 1.2 Activity 2
 1.3 Activity 3
 1.4 Activity 4
 1.5 Activity 5
 1.6 Activity 6
 ….
 1.N Activity N
 SUBTOTAL DIRECT COST
 2. INDIRECT COST
 Flat rate funding up to 7% of total
 direct cost
 TOTAL ELIGIBLE COST

Please give an indicative breakdown of estimated eligible costs of the proposed Action, i.e. the action for which a financial contribution from the TEN-T Programme is
requested in this application, by activities (Activities from section A3.1) and year (all amounts are in EUR).

For multi-beneficiary actions, please fill in a table with the global breakdown of the costs and one table per applicant with respective costs per activity. This
does not apply to multi-beneficiary actions which have a common financial structure.
                                Proposal Submission Forms
                    EUROPEAN COMMISSION             TRANS-EUROPEAN TRANSPORT NETWORK


                                                                                            A3.4
Proposal Nr.

                                              TECHNICAL INFORMATION

                                                 Proposed Action

Railways
                                                         Current                   Target
                                                  Year             Value    Year            Value
Length of the section (km)
Number of tracks
Train length
Max speed (km/h)
Axle load
Inclination (deg)
Passenger capacity (persons)
Passenger traffic flow (pax per year)
Freight capacity (t per year)
Freight traffic flow (ton-km per year)
Rail voltage (V)
Clearance or structure gauge
Voice system radio
Control and command system

Roads
                                                         Current                   Target
                                                  Year             Value    Year            Value
Length of the section (km)
Number of lanes per direction
Max speed (km/h)
Longitudinal gradient (deg)
Vehicles      capacity     per    direction
(vehicles/day)
Annual average daily traffic per lane
(vehicles/day)
Freight capacity (t per year)
Freight traffic flow (ton-km per year)
Percentage of heavy good vehicles (%)
Road toll (euros/km)
Number of fatal accidents
Electronic management system (Y/N)

Airports
                                                         Current                   Target
                                                  Year             Value    Year            Value
Number of runways
Max frequency (movements per hour)
Passenger capacity (persons)
Passenger traffic flow (pax per year)
Freight capacity (t per year)
Freight traffic flow (ton-km per year)
Max size of aircraft
Electronic management system (which)
Air Traffic Management
Functional Airspace Blocks (FABs)
                                                   Current                  Target
                                            Year             Value   Year            Value
Number of FIRs in (proposed) FAB
Number ATM systems in use in
(proposed) FAB
Number of ATCCs in (proposed) FAB
Number of Sectors in (proposed) FAB

Ports
                                                   Current                  Target
                                            Year             Value   Year            Value
Master plans (num ports)
Master plans (ha)
Master plans (t)
Breakwaters (km)
Breakwaters (m depth at entrance)
Dredged fairways and basins (m length)
Dredged fairways and basins (m wide)
Dredged fairways and basins (m of
depth)
Maritime chamber lock (m wide x m
long)
Waterway connection (UN class)
Waterway connection (t)
Rail connection (num tracks)
Rail connection (t)
Road connection (num lanes)
Road connection (t)
Port terminals (m draught)
Port terminals (m quays)
Port terminals (ha)
Combined terminals (num rail tracks)
Combined terminals (ha)
Passenger or cruise terminal (m2)
Passenger or cruise terminal (pass)
Freight capacity (t per year)
Port traffic (num vessels)
Electronic management system (which)

Inland Waterways
                                                   Current                  Target
                                            Year             Value   Year            Value
Master plans (km)
Master plans (UN class)
Master plans (t)
Section (km)
Section (reaches)
Section (UN class)
Navigation reliability (draught)
Navigation reliability (days)
Navigation reliability (%)
IWW locks (num)
IWW chamber lock (m wide)
IWW chamber lock (m long)
Local bottleneck solved (num bridge or
others)
Ports, transhipment or storage facilities
(num)
                                                   10
Ports, transhipment or storage facilities
(tons)
Freight capacity (t per year)
Freight capacity (ton x km)
IWW traffic (vessels)
IWW traffic (vessels x km)
Electronic management system (which)

Motorways of the Sea
(Corresponding component parts relating to the other modes (road, ports, IWW, rail) should be also
be filled out for MoS actions)
                                                Current                         Target
                                          Year          Value            Year            Value
Distance of maritime part of link (nm)
Vessels (type: cont or ro/ro)
Vessels (type: number)
Vessels (capacity: TEU or lm)
Traffic volume (t per year)
Frequency of departure (e.g.: 1/day)
Average vessel turn around time (hours
in ports per call)
Duration of action (number of years)
Total modal shift (ton/km)
Total CO2 emissions
Electronic management system (which)




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Final Notes:
The following fields will provide a drop down list with values (see e-Application form - Part A - Annex for values):

   –   Priority/Horizontal Project
   –   Section
   –   Transport mode
   –   Member State(s)
   –   Region(s)
   –   ISIC code




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