ANNEX VSupplementary provisions
ANNEX V FINAL FINANCIAL REPORT AND PAYMENT APPLICATION One table per survey in poultry/wild birds ( 1 ) Text of image Member State: Date: Reporting period from: to: Measures eligible for co-financing (a) Methods of laboratory analysis Number tests performed per method Costs Serological pre-screening (b) Haemagglutination-inhibition-test (HI) for H 5/H 7 Virus isolation test PCR test Other measures to be covered Specify activities Sampling Others Total (a) Data to be given in national currency, VAT excluded. (b) Please indicate test used. Herewith I certify that the data given above are correct and that no other Community contribution was asked for these measures. (Place, Date) (Signature) ( 1 ) Strike through as appropriate.