Financial Statement _ RFP - EACE

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Financial Statement _ RFP - EACE Powered By Docstoc
					Final report and financial statement                                                                                   Annex III/13
Tempus Project No.: ..........                                                                                         Financial statement



                                                                  FINANCIAL STATEMENT

• Column “1. Project Costs” and Column “3. Project Finance” refer to the Estimated Budget of the Action as indicated
   in Annex II of your Grant Agreement or in subsequent amendments to Annex II.
• Columns under “2. Project Expenditure” refer to expenditure made within the eligibility period (either paid from Tempus
  or co-financed).
• Under "2. Project Expenditure", the declared amounts must represent the amounts that have been actually paid (meaning
  that a disbursement has been made) and NOT committed amounts.
• Relevant supporting documents must be issued for both „Expenditure Paid from Tempus‟ and „Expenditure Co-Financed‟.



                                                                   1. PROJECT
                                                                                                 2. PROJECT EXPENDITURE €
                                                                     COSTS €
                                                                  Estimated Budget of   Declared Paid     Declared          Total
                                                                       the action
                                                                       (Annex II)
                                                                                        from Tempus      Co-financed       Declared
                   Staff costs (including
          I        replacement costs)
          II       Travel costs and Costs of Stay
          III      Equipment
          IV       Printing and publishing
          V        Other costs
          VI       Indirect Costs ¹
                                                                                        Total:          Total:         TOTAL:
          TOTAL ELIGIBLE COSTS (A.4) ²

                                                                   3. PROJECT
                                                                   FINANCE €
          A        Co-financing                                                         BANK INTEREST €³
          B+C Total from Tempus


          TOTAL PROJECT FINANCE (A.4)




                                                              REQUEST FOR PAYMENT

In accordance with articles I.4 and II.15 of the Grant Agreement (please mark the appropriate box):

                    I hereby request the payment of the balance to the following bank account:
                                                   IBAN____________________
                    I hereby do not request the payment of the balance.

          Date and signature of the legal representative of the beneficiary institution:


          Date: ____________________                                                    Signature:      _____________________

¹ Indirect costs may not be co-financed (art. 8.2, Annex IV of the Grant Agreement).
² As indicated in point A.4, first page of the Grant Agreement.
³ Bank interests have to be indicated.
Final report and financial statement                                                                                                 Annex III/14
Tempus Project No.: ..........                                                                                                       Financial statement



MOBILITY TABLE FOR TRAVEL COSTS AND COSTS OF STAY (Annex III/16)
Please make sure that these tables are completed correctly by following the instructions below:
Column 1 :           please use consecutive numbers and include the reference on the corresponding supporting documentation
Column 2 :           indicate the name of the person;
Column 3 :           indicate the reference number of the sending institution as indicated in the original application form;
Column 4 :           indicate the country code of the sending institution;
Column 5 :           for staff: indicate the status of the person claiming reimbursement at his home institution;
                     for students: indicate which course the students are following at their home institution, (e.g. B.Sc., MA.,
                     PhD, etc.) and the number of years they have already studied this course;
Column 6 :            indicate the reference number of the host institution as indicated in the original application form;
Column 7 :            indicate the country code of the host institution;
Column 8 :            indicate the start and end dates of the mobility flow;
Column 9 :            indicate the duration of the stay abroad in DAYS;
Column 10:            indicate the travel costs;
Column 11 :           indicate the grant given to cover the costs of stay;
Columns 12 & 13:      indicate the total of travel costs plus costs of stay, which should correspond to the amount reported on the
                      Individual Mobility Report (Annex IV/2 of the Grant Agreement) and provide the ‘Amount Paid from
                      Tempus’ (12) and the ‘Amount Co-financed’ (13) separately in the two columns;
Columns 14 & 15:      for students only: indicate the amount for institutional costs and provide the ‘Amount Paid from Tempus’
                      (14) and the ‘Amount Co-financed’ (15) separately in the two columns.


COUNTRY CODES (to complete the mobility tables)


European Community Member States Partner Countries                                     Other countries which may participate

                                             Balkans                                          EFTA Countries
AT    Austria                             AL Albania                                   IS     Iceland
BE    Belgium                             BA Bosnia and Herzegovina                    LI     Liechtenstein
BG    Bulgaria                            HR Croatia                                   NO     Norway
CY    Cyprus                              ME Montenegro                                CH     Switzerland
CZ    Czech Republic                      MK the former Yugoslav Republic of
DE    Germany                             RS Macedonia
                                             Serbia                                    TR     Turkey
DK    Denmark                                Kosovo *
                                          1244
EE    Estonia                                Southern Neighbouring Area
EL    Greece                              DZ Algeria
ES    Spain                               EG Egypt
FI    Finland                             IL Israel
FR    France                              JO Jordan
HU    Hungary                             LB Lebanon
IE    Ireland                             MA Morocco
IT    Italy                               PS the occupied Palestinian Territory
LT    Lithuania                           SY Syria
LU    Luxembourg                          TN Tunisia
LV    Latvia                                 Eastern Neighbouring Area
MT    Malta                               AM Armenia
NL    Netherlands                         AZ Azerbaijan
PL    Poland                              BY Belarus
PT    Portugal                            GE Georgia
RO    Romania                             MD Moldova
SE    Sweden                              RU Russian Federation
SI    Slovenia                            UA Ukraine
SK    Slovak Republic                        Central Asia
UK    United Kingdom                      KG Kyrgyzstan
                                          KZ Kazakhstan
                                          TM Turkmenistan
                                          TJ Tajikistan
                                          UZ Uzbekistan
* Under UNSCR 1244/99
Final report and financial statement                                                                                                                                              Annex III/15
Tempus Project No.: ..........                                                                                                                                                    Financial statement

I. STAFF COSTS (including replacement costs)*

                IMPORTANT NOTE: This Excel sheet is not protected or pre-formatted, meaning that you can insert rows and use calculations according to your
                 needs. Please check your calculations carefully and ensure that the declared amounts are correct.


                                                          Institution of Origin
                                                                                                                   Employed
                                                           (see annex III/14)
                                                                                                                                                           Paid from        Co-
  No. to be                                                               Current                                                                                                    TOTAL
                                                                                                          Dates (dd/mm/yy)                                 Tempus -    financed*** -
copied on the                                                 Country    occupation    Tasks performed                                                                                STAFF
                        Name of person           Ref. No.                                                                                                    Total       Total Co-
 supporting                                                    Code       at home       for the project                           Total                                              COSTS
                                                                                                                               number of Salary rate       Tempus        financed
 documents                                                               institution                                                                                                 (EURO)
                                                                                                                                  days     (per day)       (EURO)        (EURO)
                                                                                                                               working on applied**
                                                    (3)          (4)         (5)                          from         to      the project (EURO)
     1
     2
     3
     ...



                       please insert rows
total no. of supporting documents* =                                                                                                       TOTAL

For sub-contracts exceeding € 25,000 please indicate in the table below the details of the three service providers consulted during the tender procedure
(copy of the three offers are to be kept with the project accounts):

No. on
supporting                   NAME OF THE SERVICE PROVIDER                                COUNTRY
document




* Please bear in mind that staff conventions for staff and subcontractors and readable copies of invoices for each subcontracted task, must be retained with the project accounts. However,
  for sub-contracts exceeding € 25,000 a copy of the sub-contracts and related invoices must be submitted with the Final Report. For replacement costs, a staff convention for each
  replacement and a confirmation of engagement from the Member State participating institution needing the replacement must be kept (see art. 3.3, Annex IV of the Grant Agreement).
** Please refer to the reference salary rates listed in Annex IV/3 of the Grant Agreement and to Art. 3,1 of Annex IV.
*** Please note that proof of expenditure must also be retained/provided for all amounts reported under co-financing (see art. 9, Annex IV of the Grant Agreement).
Final report and financial statement                                                                                                                                                             Annex III/16
Tempus Project No.: ..........                                                                                                                                                                   Financial statement

II. TRAVEL COSTS AND COSTS OF STAY*

               IMPORTANT NOTE: This Excel sheet is not protected or pre-formatted, meaning that you can insert rows and use calculations according to
                your needs. Please check your calculations carefully and ensure that the declared amounts are correct.

                                                        Origin                              Destination                                                              Expenditure


                                                                                                                                                                                       Institutional costs
                                                                                                                              Total Travel Total Costs Total amount of travel costs      (for students
                                              Institution                   Institution     Dates (dd/mm/yy)      Duration      costs**     of stay **        + costs of stay:             only)****
  No. to be                                                  Current
 copied on                                                 occupation at                                                                                 Paid from        Co-         Paid from  Co-    Total travel
                                         Ref.      Country                 Ref.   Country
 supporting                                                   home                                                                                        Tempus      financed***      Tempus financed costs and costs
    doc.         Name of person          No.        code    institution    No.     code      from          to     (in days)    (EURO)       (EURO)        (EURO)        (EURO)         EURO) (EURO) of stay (EURO)
                                                                                                                                                                                                          (12)+(13)
     (1)                 (2)              (3)         (4)        (5)       (6)      (7)      (8/1)        (8/2)      (9)         (10)         (11)          (12)          (13)          (14)     (15)    +(14)+(15)
      1
      2
      3
      ...



                please insert rows
total no. of Individual Mobility Reports* =                                                                                               TOTAL




* Please keep the Individual Mobility Reports (Annex IV/2) together with all copies of travel tickets and invoices with the project accounts (see art. 4, Annex IV of the Grant Agreement) .
** Each amount reported in these columns should correspond to the amounts for Travel Costs and Costs of Stay for the individual as reported in the corresponding Individual Mobility Report.
   Please note that for each mobility the sum of travel costs and costs of stay (10+11) should be equal to the sum of the amount paid by Tempus and the amount co-financed (12+13).
*** Please note that proof of expenditure must also be retained for all amounts reported under co-financing (see art. 9, Annex IV of the Grant Agreement).
**** Please refer to art. 4.5.4 (institutional costs), Annex IV of the Grant Agreement.
Final report and financial statement                                                                                                                                                    Annex III/17
Tempus Project No.: ..........                                                                                                                                                          Financial statement



III. EQUIPMENT*


               IMPORTANT NOTE: This Excel sheet is not protected or pre-formatted, meaning that you can insert rows and use calculations according to
                your needs. Please check your calculations carefully and ensure that the declared amounts are correct.




                                                                                                   Equipment        Transport and    Maintenance and
   No. to be                                                                                      purchase costs installation costs   insurance costs       Paid from  Co-financed***
  copied on       Nature, type and                                                   VAT and         (EURO)            (EURO)            (EURO)             Tempus -    - Total Co-       Equipment
  supporting    specifications of the                    Beneficiary      Country    Taxes **                 (excluding VAT and taxes) **                Total Tempus    financed        Costs Total
     doc.               item            Invoice date     Institution       Code      (EURO)                                                                 (EURO)        (EURO)           (EURO)
       1
       2
       3
      ....


                 please insert rows

total no. of Equipment items* =                                                                                                     TOTAL

For equipment purchases exceeding € 25,000, please indicate the details of the three service providers consulted during the tender procedure in the table below.

(copy of the three offers are to be retained with the project accounts)
No. on
supporting                                  NAME OF THE COMPANY                                  COUNTRY
document




* Please bear in mind that copies of the invoices need not be submitted with the Final Report unless the purchase exceeds € 25.000 (see Article 5, Annex IV of the Grant Agreement).
  The documents of the tender procedures, including 3 comparable offers, must be retained with the project accounts. Where the purchase does not exceed the above-mentioned ceiling, only
  the invoices need be retained with the project accounts. For invoices in a currency other than EURO, please indicate the equivalent amount in EURO on the invoice. Any conversion of
  actual costs into EURO shall be made by the beneficiary at the monthly accounting rate established by the Commission and published on its website (http://ec.europa.eu/budget/inforeuro)
  applicable on the month of the first pre-financing until the second pre-financing is received, after which the rate of the month of the second pre-financing must be applied.
** VAT and taxes are ineligible both as „paid from Tempus' and 'co-financed‟ (see art. II.14.4 of the Grant Agreement and art. 5.5, Annex IV of the Grant Agreement).
*** Please note that proof of expenditure must also be retained/provided for all amounts reported under co-financing (see Article 9, Annex IV of the Grant Agreement).
Final report and financial statement                                                                                                                                     Annex III/18
Tempus Project No.: ..........                                                                                                                                           Financial statement




IV. PRINTING & PUBLISHING*


                    IMPORTANT NOTE: This Excel sheet is not protected or pre-formatted, meaning that you can insert rows and use calculations according to
                     your needs. Please check your calculations carefully and ensure that the declared amounts are correct.




                                                                                                                                            Paid from  Co-financed** -    Printing and
 No. to be copied                                                                                                                           Tempus -     Total Co-         Publishing
  on supporting                                                                   Company providing the     Beneficiary                   Total Tempus    financed           Total
    document            Invoice date      Type of expenditure     Purpose               service             Institution    Country Code     (EURO)        (EURO)            (EURO)
         1
         2
         3
        ...




                     please insert rows
total no. of P&P items* =                                                                                                 TOTAL




* Please do not forget to retain readable copies of all invoices with the project accounts (see art. 6, Annex IV of the Grant Agreement).
**Please note that proof of expenditure must also be retained for all amounts reported under co-financing (see art. 9, Annex IV of the Grant Agreement).
Final report and financial statement                                                                                                                                              Annex III/19
Tempus Project No.: ..........                                                                                                                                                    Financial statement




V. OTHER COSTS*


                    IMPORTANT NOTE: This Excel sheet is not protected or pre-formatted, meaning that you can insert rows and use calculations according
                     to your needs. Please check your calculations carefully and ensure that the declared amounts are correct.




                                                                                                                                               Paid from         Co-financed**-
 No. to be copied                                                                                                                              Tempus -            Total Co-       Other Costs
  on supporting        Invoice date/Bank                                                            Beneficiary                              Total Tempus          financed           Total
   documents             statement date      Type of expenditure              Purpose               Institution          Country Code          (EURO)               (EURO)          (EURO)
         1
         2
         3
        ...




                       please insert rows
total no. of Other Costs items* =                                                                                  TOTAL




* Please do not forget to retain readable copies of all invoices and bank statements with the project accounts (see art. 7, Annex IV of the Grant Agreement) .
**Please note that proof of expenditure must also be retained for all amounts reported under co-financing (see art. 9, Annex IV of the Grant Agreement).
Final report and financial statement                                                                                Annex III/20
Tempus Project No.: ..........                                                                                      Financial statement



             VI. INDIRECT COSTS*



             Please report the amount for indirect costs directly in the Financial Statement, Annex III/13
             (Point VI. Indirect Costs).**



             Note:
             At the end of the project and following the financial assessment of the Final Report, the indirect costs
             you are entitled to will be recalculated on the basis of the ACTUAL total eligible direct costs.
             Therefore, the final amount eligible for indirect costs may be different from the amount originally budgeted.

             At the end of the project and following the financial assessment, an increase up to 10% on the figure
             shown for indirect costs in Annex II of the Grant Agreement, can be allowed provided that:
             1. the amount declared corresponds to the actual indirect costs incurred;
             2. the maximum grant amount (point A.3 of the Agreement) is not exceeded;
             3. the amount does not exceed 7% of the total eligible direct costs (as recalculated during the financial
               assessment)




* No supporting documentation is required.
** No co-financing is permitted under this budget heading (see Article 8.2, Annex IV of the Grant Agreement).
Final report and financial statement                                                             Annex III/21
Tempus Project No.: ..........                                                                   Financial statement




PROJECT EXPENDITURE OF THE BENEFICIARIES (CO-FINANCING) AND EXCHANGE RATE



1. Please report the total amount for project expenditure of the beneficiaries (co-financing) in the Financial Statement,
Annex III/13 (Table 2 "Expenditures", second column), breaking it down under the respective budget headings
(I. Staff costs, II. Travel costs and costs of stay, III. Equipment, IV. Printing and publishing, V. Other costs).



2. Please then provide all details of the co-financing expenditure under the respective tables in the financial statement
(Annexes III/15-19) and ensure that related supporting documentation is provided with your Final Report where
 required, or retained with the project accounts.



3. Please indicate in the table below the exchange rates applied for the conversion of local currencies into Euro
during the two reference periods (1st period* and 2nd period**).
As regards the exchange rate to be applied, please refer to FAQ. 78 published on the Tempus website.



                       NAME OF          EXCHANGE RATE EXCHANGE RATE
                      THE LOCAL COUNTRY EUR / CURRENCY EUR / CURRENCY
                      CURRENCY             1st period*   2nd period**
                             ...              ...            ...                    ...




                     Add more lines if necessary


* 1st period: From the start of the eligibility period (15 January 2009) until the reception of the second pre-financing
              (please indicate here the date: .........................)

** 2nd period: From the second pre-financing until the end of the eligibility period.

N.B. According to art. II.14.4 of the Grant Agreement, exchange losses are not eligible.

				
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