model financial statement - european commission · 2015-12-03 · annex vi model financial...
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ANNEX VI Model Financial Statement
For good follow-up of your statement, please always save this file with project
number and acronym as follows: "Financial_statement_project_number_acronym ".
EUROPEAN COMMISSION
Executive Agency for Small and Medium-sized Enterprises (EASME)
Department A - COSME, H2020 SME and EMFF
Unit A3 - EMFF
*Please carefully fill in the reporting dates according to the Grant Agreement.
Coordinator:
Reporting Period*:
European Maritime and Fisheries Fund (EMFF)
Model Financial Statement
Project Number:
Project Full Name:
Please enter information in cells marked in green:
Ref. Ares(2015)5515622 - 02/12/2015
TO
Sta
ff
Co
sts
Su
b-c
on
tra
cti
ng
Tra
ve
l c
os
ts a
nd
Su
bs
iste
nc
e
Eq
uip
me
nt
Oth
er
Sp
ec
ific
Co
sts
1 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
Ind
ire
ct
eli
gib
le c
os
ts
Na
me
of
Be
ne
fic
iary
or
Aff
ilia
ted
en
tity
Nu
mb
er
of
Be
ne
fic
iary
or
Aff
ilia
ted
en
tity
Su
bto
tal
of
dir
ec
t
eli
gib
le c
os
ts
Direct eligible cost
TOTAL
OVERVIEW OF COSTS INCURRED FOR PERIOD N°
To
tal
eli
gib
le c
os
ts
Re
qu
es
ted
Fu
nd
ing
fro
m t
he
EU
090166e5a37a3cfd.7997193259357945531.xlsm/Overview of the costs incurred Page 2 of 51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff /In-house
consultants
Number
of person-
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00Subtotal
Subtotal
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Description of the work undertaken
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Name of Subcontractor
Category name (e.g. senior expert,
engineer, etc.)Name
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 3/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
Subtotal
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 4/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Total direct eligible costs 0,00
Total eligible costs 0,00
Date:
Name of the Legal
Representative of the
Coordinator or his/her
Authorised
Representative
Signature of the Name
of the Legal
Representative of the
Coordinator or his/her
Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court of Auditors and reflect the
costs actually incurred.
Sources of revenue (3rd parties, sales or other contributions)
Subtotal
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Name of supplier Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 5/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person-
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Description of the work undertakenName of Subcontractor
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 6/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
PurposeDestination (city, country)
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
Subtotal
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 7/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were
necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the
purposes of audit by the EASME and its authorised representatives or the Court of Auditors and reflect the costs actually
incurred.
To be completed only at the Final Statement.Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Name of supplier Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 8/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person-
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Name of Subcontractor
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Description of the work undertaken
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 9/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Description
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 10/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Subtotal
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court of Auditors and reflect the
costs actually incurred.
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Name of supplier
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 11/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°Staff
Number
of man-hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Description of the work undertakenName of Subcontractor
Name
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 12/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Destination (city, country) Purpose
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 13/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
DescriptionName of supplier
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 14/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person-
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Name of Subcontractor
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Description of the work undertaken
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 15/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
PurposeDestination (city, country)
Description
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 16/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Name of supplier
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Subtotal
REVENUES OTHER THAN EMFF FUNDING PROGRAMME AND OWN FUNDING (6)
Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 17/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person-
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive
offers from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential
contractors and shall take care to avoid any conflict of interests.
Name of Subcontractor Description of the work undertaken
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 18/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of
the same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the
EASME, except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by
the Commission.
Destination (city, country) Purpose
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 19/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Sources of revenue (3rd parties, sales or other contributions)
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court of Auditors and reflect
the costs actually incurred.
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Name of supplier
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 20/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Name of Subcontractor
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Subtotal
Description of the work undertaken
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 21/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice numberQuantity Unit cost
Period in
months used
for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Description
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME, except
where the nature and/or the context of its use justifies different treatment by the EASME.
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
Destination (city, country) Purpose
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 22/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or his/her
Authorised
Representative
Signature of the Legal
Representative or his/her
Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the FinalStatement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Name of supplier
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 23/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Description of the work undertakenName of Subcontractor
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 24/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
Destination (city, country) Purpose
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 25/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Total direct eligible costs 0,00
Date: Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Name of supplier
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 26/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person-
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Description of the work undertakenName of Subcontractor
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Subtotal
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 27/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 28/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Name of supplier Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 29/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Name of Subcontractor
Subtotal
Description of the work undertaken
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 30/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
Destination (city, country) Purpose
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 31/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Name of supplier
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 32/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Description of the work undertakenName of Subcontractor
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 33/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Description
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 34/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Sources of revenue (3rd parties, sales or other contributions)
Subtotal
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Name of supplier
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 35/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Description of the work undertakenName of Subcontractor
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 36/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice numberQuantity Unit cost
Period in
months used
for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
Destination (city, country) Purpose
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME, except
where the nature and/or the context of its use justifies different treatment by the EASME.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 37/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Date: Total direct eligible costs 0,00
Total eligible costs 0,00
Name of the Legal
Representative or his/her
Authorised
Representative
Signature of the Legal
Representative or his/her
Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Name of supplier Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 38/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
Description of the work undertakenName of Subcontractor
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive
offers from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential
contractors and shall take care to avoid any conflict of interests.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 39/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of
the same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the
EASME, except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by
the Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 40/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Total direct eligible costs 0,00
Total eligible costs 0,00
Date:
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the
Legal
Representative or
his/her Authorised
Representative
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
DescriptionName of supplier
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the
Court of Auditors and reflect the costs actually incurred.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 41/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Name of Subcontractor
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive
offers from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential
contractors and shall take care to avoid any conflict of interests.
Description of the work undertaken
Subtotal
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 42/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice
number
Quantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by
the Commission.
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of
the same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the
EASME, except where the nature and/or the context of its use justifies different treatment by the EASME.
Description
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 43/51
Partner 1
OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Total direct eligible costs 0,00
Total eligible costs 0,00
Date:
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the
Legal
Representative or
his/her Authorised
Representative
Subtotal
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Name of supplier
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the
Court of Auditors and reflect the costs actually incurred.
Description
Sources of revenue (3rd parties, sales or other contributions)
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 44/51
Partner 1
Reporiting period N°:
For the period from to
Name of the Beneficiary/Affiliated entity:
My organisation can not claim the VAT back :
STAFF COSTS (1)
Line
N°
Staff/In-house
consultants
Number
of person -
hours
Hourly
rate
Staff costs
amount
A B AxB
1 0,00
2 0,00
3 0,00
4 0,00
5 0,00
6 0,00
7 0,00
8 0,00
9 0,00
10 0,00
11 0,00
12 0,00
13 0,00
14 0,00
15 0,00
16 0,00
17 0,00
18 0,00
19 0,00
20 0,00
0,00 0,00
SUBCONTRACTING (2)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Description of the work undertakenName of Subcontractor
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
If the beneficiaries have to conclude contracts in order to carry out the action and they constitute costs of the action under an item of eligible direct costs in the estimated budget, they shall seek competitive offers
from potential contractors and award the contract to the bid offering best value for money; in doing so, they shall observe the principle of transparency and equal treatment of potential contractors and
shall take care to avoid any conflict of interests.
Copies of timesheets and justification for labour rate and overhead rate calculations for the three highest cost items must be attached to the Financial Statement. Copies of other timesheets and
justification for labour rate and overhead rate calculations may be requested by the EASME at anytime.
The cost of staff assigned to the action, comprising actual salaries plus social security charges and other statutory costs included in the remuneration, provided that this does not exceed the average
rates corresponding to the beneficiary's usual policy on remuneration. EASME will not accept any specific bonuses paid out only for the participation in EU projects.
Category name (e.g. senior expert,
engineer, etc.)Name
Subtotal
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 45/51
Partner 1
TRAVEL AND SUBSISTENCE (3)
Line
N°Name
Date
(dd/mm/yy)
Duration
(days)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
EQUIPMENT AND INFRASTRUCTURE (4)
Line
N°
Date of the invoice
AND invoice numberQuantity Unit cost
Period in
months
used for the
project
during the
correct
reporting
period
Depreciation
in months
% Allocation
to projectAmount
A B C D E AxBx(C/D)xE
1 #DIV/0!
2 #DIV/0!
3 #DIV/0!
4 #DIV/0!
5 #DIV/0!
6 #DIV/0!
7 #DIV/0!
8 #DIV/0!
9 #DIV/0!
10 #DIV/0!
11 #DIV/0!
12 #DIV/0!
13 #DIV/0!
14 #DIV/0!
15 #DIV/0!
16 #DIV/0!
17 #DIV/0!
18 #DIV/0!
19 #DIV/0!
20 #DIV/0!
Subtotal 0,00
Description
Subtotal
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASMEat anytime.
The purchase cost of equipment (new or second-hand), provided that it is depreciated in accordance with the tax and accounting rules applicable to the beneficiary and generally accepted for items of the
same kind. Only the portion of the equipment's depreciation corresponding to the correct reporting period and the rate of actual use for the purposes of the action may be taken into account by the EASME,
except where the nature and/or the context of its use justifies different treatment by the EASME.
Destination (city, country) Purpose
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of other invoices may be requested by the EASME at anytime.
Travel and subsistence allowances for staff taking part in the action, provided that they are in line with the beneficiary's usual practices on travel costs or do not exceed the scales approved annually by the
Commission.
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 46/51
Partner 1OTHER SPECIFIC COSTS (5)
Line
N°Date of the invoice Invoice number Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0,00
Line
N°
Date of funding
(dd/mm/yy)Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal 0,00
Total direct eligible costs 0,00
Total eligible costs 0,00
Date:
Name of the Legal
Representative or
his/her Authorised
Representative
Signature of the Legal
Representative or
his/her Authorised
Representative
Statement by the beneficiary
I certify that:
- the above costs correspond to the resources employed for the work under the agreement and that those resources were necessary for the work,
- the costs were incurred and fall within the definition of eligible costs,
- where necessary, authorisations have been obtained from the EASME, and
- all the documents supporting the allowable costs reported above, including the time records are available for the purposes of audit by the EASME and its authorised representatives or the Court
of Auditors and reflect the costs actually incurred.
REVENUES OTHER THAN EMFF PROGRAMME AND OWN FUNDING (6)
To be completed only at the Final Statement. Revenues from the action (3rd parties, sales or other contributions), excluding financial contribution of the EMFF programme and own funding.
Sources of revenue (3rd parties, sales or other contributions)
Subtotal
Description
Copies of invoices for the three highest cost items must be attached to the Financial Statement. Copies of the other invoices may be requested by the EASME at anytime.
Name of supplier
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 47/51
(1) Calendar days per year minus weekends 261
(2) Annual holidays (in n° of days)
(3) Statutory holidays (in nº of days)
(4) Others (i.e. illness etc.) (in n° of days) PLEASE SPECIFY
(5) Productive days per year: (1) - (2) - (3) - (4) 261
(6) Working hours per day
(7) Annual working hours: (1) x (6) 0
(8) Productive hours per year: (5) x (6) 0 (A)
(9) Productive hours per month 0 (A)/ 12
Staff / in-
house
consultant
Staff Name Staff Category
Salary cost per year
(Staff) - Hourly rate
as per contract (in-
house consultant)
Social charges per
year (Staff)%
Other Costs per
year (Staff)
Total annual cost
per employee
Hourly
Labour rate
(Total annual
costs per
person / A)
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
#DIV/0! - #DIV/0!
ANNUAL WORKED HOURS
HOURLY RATE CALCULATION TEMPLATE
(This is for information purpose only, and it is not required to submit this worksheet with your financial statement)
090166e5a37a3cfd.7997193259357945531.xlsm 02/12/2015 48/51
EUR
BGN
CYP
CZK
DKK
EEK
HUF
LVL
LTL
PLN
RON
SEK
GBP
AED
AFN
ALL
AMD
ANG
AOA
ARS
AUD
AWG
AZN
BAM
BBD
BDT
BHD
BIF
BMD
BND
BOB
BRL
BSD
BTN
BWP
BYR
BZD
CAD
CDF
CHF
CLP
CNY
COP
CRC
CSD
CUC
CVE
DJF
DOP
DZD
EGP
ERN
ETB
FJD
FKP
GEL
GHS
GIP
GMD
GNF
GTQ
GYD
HKD
HNL
HRK
HTG
IDR
ILS
INR
IQD
IRR
ISK
JMD
JOD
JPY
KES
KGS
KHR
KMF
KPW
KRW
KWD
KYD
KZT
LAK
LBP
LKR
LRD
LSL
LYD
MAD
MDL
MGA
MKD
MMK
MNT
MOP
MRO
MUR
MVR
MWK
MXN
MYR
MZN
NAD
NGN
NIO
NOK
NPR
NZD
OMR
PAB
PEN
PGK
PHP
PKR
PYG
QAR
RSD
RUB
RWF
SAR
SBD
SCR
SDG
SGD
SHP
SLL
SOS
SRD
STD
SVC
SYP
SZL
THB
TJS
TMT
TND
TOP
TRY
TTD
TWD
TZS
UAH
UGX
USD
UYU
UZS
VEF
VND
VUV
WST
XAF
XCD
XOF
XPF
YER
YUM
ZAR
ZMK
ZWL