LIFE Environment and Resource Efficiency
TECHNICAL APPLICATION FORMS
Part A – administrative information
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Printed out on : 22/05/2017 02:36
LIFE17 ENV/
FOR ADMINISTRATION USE ONLY
LIFE17 ENV/
LIFE Environment and Resource Efficiency project application
Language of the proposal:
English (en)
Project title (max 120 characters):
Project acronym (max 25 characters):
The project will be implemented in the following Member State(s) and Region(s) or other
countries:
Expected start date:
Expected end date:
LIST OF BENEFICIARIES
Name of the coordinating beneficiary:
LIST OF CO-FINANCERS
PROJECT BUDGET AND REQUESTED EU FUNDING
Total project budget:
Euro
Total eligible project budget:
Euro
EU financial contribution requested:
Euro
(= %
SECTOR
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of total eligible budget)
LIFE17 ENV/ - A2
Coordinating Beneficiary Profile Information
Legal Name (max
200 characters)
Short Name (max 10
characters)
Legal Status
VAT No
Public
body Private
Legal Registration
commercial Private
Registration Date
non- commercial
Pic Number (not
compulsory)
Legal entity is SME
Employee number
Legal address of the Coordinating Beneficiary
Street Name and No
Post Code
PO Box
Town / City
Member State
Coordinating Beneficiary contact person information
Title
Function
Surname
First Name
E-mail address
Department /
Street Name and No
Post Code
PO Box
Town / City
Member State
Telephone No
Fax No
Website of the Coordinating Beneficiary
Website (max 250
characters)
Brief description of the Coordinating Beneficiary's activities and experience in the area of the
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LIFE17 ENV/ - A7
OTHER PROPOSALS SUBMITTED FOR EUROPEAN UNION FUNDING
Please answer each of the following questions:
• Have you or any of your associated beneficiaries already benefited from previous LIFE cofinancing?
(please cite LIFE project reference number, title, year, amount of the co-financing, duration, name(s) of
coordinating beneficiary and/or partners involved):
• Have you or any of the associated beneficiaries submitted any actions related directly or indirectly to
this project to other European Union funding programmes? To whom? When and with what results?
• For those actions which fall within the eligibility criteria for financing through other European Union
funding programmes, please explain in full detail why you consider that those actions are better
suited to financing through LIFE and are therefore included in the current project:
• Has this proposal been submitted before?
Yes
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No
LIFE17 ENV/
TECHNICAL APPLICATION FORMS
Part B - technical summary and overall
context of the project
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LIFE17 ENV/ - B1
SUMMARY DESCRIPTION OF THE PROJECT (Max. 3 pages; to be completed in English)
Project title (max 120 characters):
Project objectives (max 2500 characters):
Actions and means involved (max 2500 characters):
Expected results (outputs and quantified achievements) (max 2500 characters):
Is your project significantly climate-related?
Yes
No
Is your project significantly biodiversity-related?
Yes
No
The proposal addresses the following project topic(s) (pasirenkama iš sąrašo, daugiausia 2):
Reasons why the proposal falls under the selected project topic(s):
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LIFE17 ENV/ - B2
ENVIRONMENTAL PROBLEM TARGETED (max 10,000 characters)
PROJECT PILOT / DEMONSTRATION CHARACTER OF THE PROJECT (max 10,000
characters)
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LIFE17 ENV/ - B3
EU ADDED VALUE OF THE PROJECT AND ITS ACTIONS (max 10,000 characters)
REPLICABILITY AND TRANSFERABILITY (max 10,000 characters)
SOCIO-ECONOMIC EFFECTS OF THE PROJECT (max 10,000 characters)
EFFORTS FOR REDUCING THE PROJECT'S "CARBON FOOTPRINT" (max 10,000 characters)
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LIFE17 ENV/ - B4
STAKEHOLDERS INVOLVED AND MAIN TARGET AUDIENCE OF THE PROJECT (OTHER THAN PROJECT
PARTICIPANTS) (max 12,000 characters)
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LIFE17 ENV/ - B5
EXPECTED CONSTRAINTS AND RISKS RELATED TO THE PROJECT IMPLEMENTATION AND MITIGATION
STRATEGY (max 12,000 characters)
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LIFE17 ENV/ - B6
CONTINUATION / VALORISATION AND LONG TERM SUSTAINABILITY OF THE PROJECT'S RESULTS AFTER
THE END OF THE PROJECT
Which actions will have to be carried out or continued after the end of the project? (max 5,000 characters)
How will this be achieved? What resources will be necessary to carry out these actions? (max 5,000 characters)
To what extent will the results and lessons of the project be actively disseminated after the end of the project to
those persons and/or organisations that could best make use of them (please identify these
persons/organisations)? (max 5,000 characters)
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LIFE17 ENV/
TECHNICAL APPLICATION FORMS
Part C – detailed technical description of the
proposed actions
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LIFE17 ENV/ - C0
LIST OF ALL PROPOSED ACTIONS
A. Preparatory actions (if needed)
B. Implementation actions (obligatory)
C. Monitoring of the impact of the project actions (obligatory)
D. Public awareness and dissemination of results (obligatory)
E. Project management (obligatory)
For each action, the applicant should provide the following information:
 Name of the action (max 200 characters):
 Beneficiary responsible for implementation (pasirenkama iš sąrašo, jei daugiau partnerių atsakingų už
vieną veiklą - aprašymui daugiausia 500 ženklų):
 Description (what, how, where, when and why) (max 7,000 characters):
 Assumptions related to major costs of the action (max 2,000 characters):
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LIFE17 ENV/ - C2
DELIVERABLE PRODUCTS OF THE PROJECT
Number of the
associated action
Name of the Deliverable
Deadline
MILESTONES OF THE PROJECT
Number of the
associated action
Name of the Milestone
Deadline
ACTIVITY REPORTS FORESEEN
Please indicate the deadlines for the following reports:
• Progress Reports n°1, n°2 etc. (if any; to ensure that the delay between consecutive reports
does not exceed 18 months)
• Mid term report payment request (for project longer than 24 months or with Eu contribution
of more than EUR300,000)
• Final Report with payment request (to be delivered within 3 months after the end of the
project)
Type of report
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Deadline
LIFE17 ENV/
FINANCIAL APPLICATION FORMS
Part F – financial information
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LIFE17 ENV/ R1 - Budget
Total cost in €
Eligible Cost in €
% of total eligible
costs
1. Personnel
0
0
0.00%
2. Travel and subsistence
0
0
0.00%
3. External assistance
0
0
0.00%
Infrastructure
0
0
0.00%
Equipment
0
0
0.00%
Prototype
0
0
0.00%
Budget breakdown cost categories
4. Durable goods
5. Land
Not applicable
6. Consumables
0
0
0.00%
7. Other costs
0
0
0.00%
8. Overheads
0
0
0.00%
Total
0
0
100.00%
In €
% of total
% of total eligible
costs
EU contribution requested
0
0.00%
0.00%
Coordinating Beneficiary's contribution
0
0.00%
Associated Beneficiaries' contribution
0
0.00%
Co-financers contribution
0
0.00%
Total
0
0.00%
Contribution breakdown
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LIFE17 ENV/ - R2 - Costs per Action
Cost category in Euro
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LIFE17 ENV/ - R2a
Costs per Beneficiary
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LIFE17 ENV/ - FC
Coordinating Beneficiary's contribution
Country code
Beneficiary short name
Total costs of the
actions in €
(including
overheads)
LT
Beneficiary's own
contribution in €
0
Amount of EU
contribution
requested in €
0
0
Associated Beneficiaries' contribution
Country code
Beneficiary short name
Total costs of the
actions in €
(including
overheads)
Associated
beneficiary's own
contribution in €
Amount of EU
contribution
requested in €
TOTAL Associated Beneficiaries
0
0
0
TOTAL All Beneficiaries
0
0
0
Co-financers contribution
Amount of cofinancing in €
Co-financer's name
0
TOTAL
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