Excel Sheet Download 30811 | Annex Iii Fin Report Final

Partial file snippet.

Sheet 1: FR01

	
	
	
	
	
	
	
	
	
		STANDARD PAYMENT REQUEST AND FINANCIAL STATEMENT
		
	
		

		

		

		

		

		

		

		

		

	
	
		To be completed only by the Co-ordinator
		
	
		

		

		

		

		

		

		

		

		

	
	
		Grant agreement number
		

		
	
		

		

		

		

		

		

		

		

		

	
	
		Legal name of Co-ordinator
		

		
	
		

		

		

		

		

		

		

		

		

	
	
		Address
		

		
	
		

		

		

		

		

		

		

		

		

	
	
		Reference period               Eligiblity period
		From:
		To:
		
	
		

		

		

		

		

		

		

		

		

	
	
		Banking details:
		Name and address of the bank
		

		
	
		Bank account n°
		

		
	
		I.B.A.N
		

		
	
		Bank account holder
		

		
	
		Payment reference (if necessary)
		

		
	
		

		

		

		

		

		

		

		

		

	
	
		Type of payment requested: 
		

		

		

		First pre-financing
		

		

		

		

	
	
		(Please tick appropriate box)
		

		

		

		Further pre-financing/interim payment
		

		

	
	
		

		

		

		

		Payment of the balance
		

		

	
	
		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

	
	
		I certify on my honour that the information contained  in this payment request is full, reliable and true. I also certify that the costs incurred can be considered eligible in accordance with the grant agreement and that this request for payment is substantiated by adequate supporting documents that can be checked (does not apply to the first installment of pre-financing).
		
	
		

		

		

		

		

		

		

		

		

	
	
		Name of legal/                            statutory representative:
		

		

		

		

		

		

	
	
		Title:
		

		

		

		

		

		

	
	
		Function:
		

		

		

		

		

		

	
	
		Date:
		

		

		

		

		

		

	
	
		Signature:
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

	
	
		Enclosures: (do not apply for the first installment of pre-financing)
		

		

		

		

		

		

		

		

	
	
		- Excel Workbook either on a diskette, CD-Rom or sent by e-mail
		

		

		

		

		

		

		

		

	
	
		- External audit report if appropriate
		

		

		

		

		

		

		

		

	



Sheet 2: FR02

	
	
	
	
	
	
	
		Consolidated Cost Statement for the Action
		
	
		

		

		

		

		

		

	
	
		ATTENTION/ to be completed by the Co-ordinator only if the project involves one or more Co-beneficiaries
		
	
		

		

		

		

		

		

	
	
		Part A: Eligible cost categories
		Rate %
		€
		Part B: Financing Plan
		€
		% of eligible costs
	
	
		A: Personnel
		0.00
		EU contribution*
		

		 
	
	
		B: Travel and subsistence
		0.00
		Contribution of the Co-ordinator
		

		 
	
	
		C: Equipment
		0.00
		Contribution of the Co-beneficiary(ies)
		

		 
	
	
		D: Sub-contracting / External assistance
		0.00
		Other sources of funding
		

		 
	
	
		E: Other direct costs 
		0.00
		Direct revenues
		

		 
	
	
		Indirect costs / overheads
		0.00%
		

		 
		

	
	
		TOTAL ELIGIBLE COSTS
		0.00
		TOTAL
		0.00
		

	
	
		* eligible costs x  EU-funding rate OR maximum EU-contribution, whatever is lower!
		
	
		

		
	
		

		 
	
	
		For information only
		

		

		

		

	
	
		"In kind" contributions / costs not included in the budget (ineligible costs)
		0.00
		

		

		

	
	
		

		

		

		

		

		

	
	
		

		

		

		

		

		

	
	
		

		

		

		Date and signature
		

		

	



Sheet 3: FR03

	
	
	
	
	
	
	
		Participant Cost Statement Summary
		
	
		

		

		

		

		

		

	
	
		Name of participant reporting own costs: 
		

		
	
		

		

		

		

		

		

	
	
		Part A: Eligible cost categories
		Rate %
		€
		Part B: Financing Plan
		€
		% of eligible costs
	
	
		Personnel
		0.00
		EU-contribution*
		

		 
	
	
		Travel and subsistence
		0.00
		Contribution of the  Co-ordinator 
		

		 
	
	
		Equipment
		0.00
		Contribution of the Co-beneficiary(ies) 
		0.00
		 
	
	
		Sub-contracting / External assistance
		0.00
		Other sources of funding
		0.00
		 
	
	
		Other direct costs
		0.00
		Direct revenues
		0.00
		 
	
	
		Indirect costs / overheads
		0.00%
		

		In kind contributions
		0.00
		 
	
	
		TOTAL ELIGIBLE COSTS
		0.00
		TOTAL
		0.00
		 
	
	
		* eligible costs x  EU-funding rate OR maximum EU-contribution, whatever is lower!
		
	
		

		
	
		

		 
	
	
		

		

		

		

		
	
		VAT-status (please tick appropriate box)
		

		

		

		

		

	
	
		□ The reported costs are without VAT.
		

		

		Date and signature
		

		

	
	
		□ VAT is not recoverable and is therefore included in the reported costs. (Proof of non-recoverability attached)

The words contained in this file might help you see if this file matches what you are looking for:

...Sheet fr standard payment request and financial statement to be completed only by the coordinator grant agreement number legal name of address reference period eligiblity from banking details bank account n deg iban holder if necessary type requested first prefinancing please tick appropriate box further prefinancinginterim balance i certify on my honour that information contained in this is full reliable true also costs incurred can considered eligible accordance with for substantiated adequate supporting documents checked does not apply installment statutory representative title function date signature enclosures do excel workbook either a diskette cdrom or sent email external audit report consolidated cost action attention project involves one more cobeneficiaries part categories rate euro b financing plan personnel eu contribution travel subsistence c equipment cobeneficiary ies d subcontracting assistance other sources funding e direct revenues indirect overheads total x eufunding...

STANDARD PAYMENT REQUEST AND FINANCIAL STATEMENT

*To be completed only by the Co-ordinator*

Grant agreement number

Legal name of Co-ordinator

Address

Reference period Eligiblity period		From:		To:

Banking details:	Name and address of the bank
	Bank account n°
	I.B.A.N
	Bank account holder
	Payment reference (if necessary)

Type of payment requested:			First pre-financing
*(Please tick appropriate box)*			Further pre-financing/interim payment
			Payment of the balance


I certify on my honour that the information contained in this payment request is full, reliable and true. I also certify that the costs incurred can be considered eligible in accordance with the grant agreement and that this request for payment is substantiated by adequate supporting documents that can be checked (does not apply to the first installment of pre-financing).

Name of legal/ statutory representative:
Title:
Function:
Date:
Signature:

*Enclosures: (do not apply for the first installment of pre-financing)*
*- Excel Workbook either on a diskette, CD-Rom or sent by e-mail*
*- External audit report if appropriate*

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Consolidated Cost Statement for the Action

*ATTENTION/ to be completed by the Co-ordinator only if the project involves one or more Co-beneficiaries*

Part A: Eligible cost categories	Rate %	€	Part B: Financing Plan	€	% of eligible costs
A: Personnel		0.00	EU contribution*
B: Travel and subsistence		0.00	Contribution of the Co-ordinator
C: Equipment		0.00	Contribution of the Co-beneficiary(ies)
D: Sub-contracting / External assistance		0.00	Other sources of funding
E: Other direct costs		0.00	Direct revenues
Indirect costs / overheads	0.00%
TOTAL ELIGIBLE COSTS		0.00	TOTAL	0.00
* eligible costs x EU-funding rate OR maximum EU-contribution, whatever is lower!


For information only
"In kind" contributions / costs not included in the budget (ineligible costs)		0.00


			Date and signature

Participant Cost Statement Summary

Name of participant reporting own costs:

Part A: Eligible cost categories	Rate %	€	Part B: Financing Plan	€	% of eligible costs
Personnel		0.00	EU-contribution*
Travel and subsistence		0.00	Contribution of the Co-ordinator
Equipment		0.00	Contribution of the Co-beneficiary(ies)	0.00
Sub-contracting / External assistance		0.00	Other sources of funding	0.00
Other direct costs		0.00	Direct revenues	0.00
Indirect costs / overheads	0.00%		In kind contributions	0.00
TOTAL ELIGIBLE COSTS		0.00	TOTAL	0.00
* eligible costs x EU-funding rate OR maximum EU-contribution, whatever is lower!



VAT-status (please tick appropriate box)
□ The reported costs are without VAT.			Date and signature
□ VAT is not recoverable and is therefore included in the reported costs. (Proof of non-recoverability attached)

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