ANNEX IVSupplementary provisions
ANNEX IV "ANNEX X CERTIFICATE AND STATEMENT OF EXPENDITURE AND APPLICATION FOR INTERIM PAYMENT Text of image EUROPEAN COMMISSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fund or Funds concerned Certificate and statement of expenditure and payment application Name of operational programme: … Commission Decision: … of … Commission reference (CCI) No: … National reference (if any): … Text of image CERTIFICATE I, the undersigned, representing the certifying authority designated by (1) hereby certify that all expenditure included in the attached statement complies with the criteria for eligibility of expenditure set out in Article 56 of Regulation (EC) No 1083/2006 and has been paid by the beneficiaries on the implementation of the operations selected under the operational programme in accordance with the conditions for granting of public contributions under Article 78 of Regulation (EC) No 1083/2006 after (2) .. .. 20.. and amounts to Euro (3) (exact figure to two decimal places) The attached statement of expenditure, broken down by priority, is based on accounts provisionally closed on .. .. 20.. and forms an integral part of this certificate. I also certify that operations are progressing in pursuance with the objectives laid down in the Decision and in accordance with Regulation (EC) No 1083/2006, and in particular that: (1) the expenditure declared complies with the applicable Community and national rules and has been paid in respect of operations selected for funding in accordance with the criteria applicable to the operational programme and the applicable Community and national rules, in particular: — State aid rules, — Public procurement rules, — Rules on the justification of advances in the framework of state aid under Article 87 of the EC Treaty by expenditure paid out by the beneficiary within a three years deadline; (2) the statement of expenditure is accurate, results from reliable accounting systems and is based on verifiable supporting documents; (3) the underlying transactions are lawful and comply with the rules and the procedures have been followed satisfactorily; (4) the statement of expenditure and the payment application take account, where applicable, of any amounts recovered (4) and of any interest on late payments received as referred to in Article 70(1)b of Regulation (EC) No 1083/2006 , and of revenue accruing from operations financed under the operational programme; (5) the breakdown of the underlying operations is recorded on computer files and is available to the relevant Commission departments on request. In accordance with Article 90 of Regulation (EC) No 1083/2006, the supporting documents are and will continue to be available for at least three years following the closure of the operational programme by the Commission (without prejudice to the special conditions laid down in Article 100(1) of that Regulation). Date .. .. 20.. Name in capitals, stamp, position and signature of competent authority … (1) Indicate the administrative instrument of designation in accordance with Article 59 of Regulation (EC) No 1083/2006 with any references and the date. (2) Reference date according to the Decision. (3) Total amount of eligible expenditure paid by beneficiaries. (4) Article 20(2b) of Regulation (EC) No 1828/2006 shall apply in relation to the exchange rate. Text of image Statement of expenditure by priority axis: Interim payment Operational Programme reference (CCI No): … Name of programme: … Date of provisional closure of accounts: … Date of sending to the Commission: … Total certified eligible expenditure paid: … Priority Axis Basis for calculating Community contribution (public or total) (1) 2007-2015 Total amount of eligible expenditure paid by beneficiaries Corresponding public contribution Priority Axis 1 Priority Axis 2 Priority Axis 3 Total for regions not receiving transitional support Total for regions receiving transitional support Technical assistance: Total Grand total NB: If an operational programme is multi-objective or multi-Fund, the priority axis shall indicate the objective(s) and Fund(s) concerned. (1) This co-financing rate and the method for its calculation are found in the financial table of the operational programme for the priority axis concerned. Text of image APPLICATION FOR PAYMENT: Interim payment Name of operational programme: … Operational programme reference (CCI) No: … Fund(s): … Pursuant to Article 61 of Regulation (EC) No 1083/2006, I, the undersigned (name in capitals, stamp, position and signature of competent authority), hereby request that you pay by way of intermediate payment the sum of: In EUR Convergence Objective European Competitiveness and Employment Objective European territorial Cooperation Objective ERDF ESF Cohesion Fund This application is admissible because: Delete as appropriate (a) no more than the maximum amount of assistance from the Funds as laid down in the decision of the Commission approving the operational programme has been paid by the Commission during the whole period for each priority axis (b) the managing authority has sent the Commission the most recent annual implementation report in accordance with Article 67(1) and (3) of Regulation (EC) No 1083/2006 — has been forwarded by the managing authority within the time limit laid down — is attached — is not due (c) there is no reasoned opinion by the Commission in respect of an infringement under Article 226 of the EC Treaty, as regards the operation(s) for which the expenditure is declared in the application for payment The payment should be made by the Commission to the body designated by the Member State for the purposes of making payments Designated body Bank Bank account No Holder of account (where not the same as the designated body) Date .. .. 20.. Name in capitals, stamp, position and signature of competent authority … Text of image Certificate and statement of expenditure and application for final payment EUROPEAN COMMISSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fund or Funds concerned Certificate and statement of expenditure and payment application Name of operational programme: … Commission Decision: … of … Commission reference (CCI) No: … National reference (if any): … Text of image CERTIFICATE I, the undersigned, representing the certifying authority designated by (1) hereby certify that all expenditure included in the attached statement complies with the criteria for eligibility of expenditure set out in Article 56 of Regulation (EC) No 1083/2006 and has been paid by the beneficiaries on the implementation of the operations selected under the operational programme in accordance with the conditions for granting of public contributions under Article 78 of Regulation (EC) No 1083/2006 after (2) .. .. 20.. and amounts to euro (3) (exact figure to two decimal places) The attached statement of expenditure, broken down by priority, is based on accounts closed on .. .. 20.. and forms an integral part of this certificate. I also certify that operations have been carried out in pursuance of the objectives laid down in the Decision and in accordance with Regulation (EC) No 1083/2006, and in particular that: (1) the expenditure declared complies with the applicable Community and national rules and has been paid in respect of operations selected for funding in accordance with the criteria applicable to the operational programme and the applicable Community and national rules, in particular: — State aid rules, — Public procurement rules, — Rules on the justification of advances in the framework of state aid under Article 87 of the EC Treaty by expenditure paid out by the beneficiary within a three years deadline, — no declaration of expenditure concerning major projects which have not been approved by the Commission; (2) the statement of expenditure is accurate, results from reliable accounting systems and is based on verifiable supporting documents; (3) the underlying transactions are lawful and comply with the rules and the procedures have been followed satisfactorily; (4) the statement of expenditure and the payment application take account, where applicable, of any amounts recovered (4) and of any interest on late payments received as referred to in Article 70(1)b of Regulation (EC) No 1083/2006, and of revenue accruing from operations financed under the operational programme; (5) the breakdown of the underlying operations is recorded on computer files and is available to the relevant Commission departments on request. In accordance with Article 90 of Regulation (EC) No 1083/2006, the supporting documents are and will continue to be available for at least three years following the closure of the operational programme by the Commission (without prejudice to the special conditions laid down in Article 100(1) of that Regulation). Date .. .. 20.. Name in capitals, stamp, position and signature of competent authority … (1) Indicate the administrative instrument of designation in accordance with Article 59 of Regulation (EC) No 1083/2006 with any references and the date. (2) Reference date according to the Decision. (3) Total amount of eligible expenditure paid by beneficiaries. (4) Article 20(2b) of Regulation (EC) No 1828/2006 shall apply in relation to the exchange rate. Text of image Statement of expenditure by priority axis: payment of the balance Operational Programme reference No (CCI No): … Name of programme: … Date of final closure of accounts: … Date of submission to the Commission: … Total certified eligible expenditure paid: Priority Axis Basis for calculating Community contribution (public or total) (1) 2007-2015 Total amount of eligible expenditure paid by beneficiaries Corresponding public contribution Priority Axis 1 Priority Axis 2 Priority Axis 3 Total for regions not receiving transitional support Total for regions receiving transitional support Technical assistance: total Expenditure in the scope of the ERDF in the grand total where an operational programme is co-financed by the ESF (2) Expenditure in the scope of the ESF in the grand total where an operational programme is co-financed by the ERDF Grand total NB: If an operational programme is multi-objective or multi-fund, the priority axis shall indicate the objective(s) and Fund(s) concerned. (1) This co-financing rate and the method for its calculation are found in the financial table of the operational programme for the priority axis concerned. (2) The field shall be completed according to whether the operational programme is co-financed by the ERDF or by the ESF if use is made of the option under Article 34 (2) of Regulation (EC) No 1083/2006. Text of image APPLICATION FOR PAYMENT: payment of the balance Name of operational programme: … Operational programme reference (CCI) No: … Fund(s): … Pursuant to Article 61 of Regulation (EC) No 1083/2006, I, the undersigned (name in capitals, stamp, position and signature of competent authority), hereby request that you pay by way of final payment: In EUR Convergence Objective Regional competitiveness and Employment Objective European territorial Cooperation Objective ERDF ESF Cohesion Fund This application is admissible because: Delete as appropriate (a) the final implementation report for the operational programme in accordance with Article 67 of Regulation (EC) No 1083/2006 — has been forwarded by the managing authority within the time limit laid down — is attached (b) a closure declaration referred to in Article 62(1)(e) of Regulation (EC) No 1083/2006 — has been forwarded by the managing authority within the time limit laid down — is attached (c) there is no reasoned opinion by the Commission in respect of an infringement under Article 226 of the EC Treaty, as regards the operation(s) for which the expenditure is declared in the application for payment in question The payment should be made by the Commission to the body designated by the Member State for the purposes of making payments Designated body. Bank. Bank account No. Holder of account (where not the same as the designated body). Date .. .. 20.. Name in capitals, stamp, position and signature of competent authority … ANNEX XI ANNUAL STATEMENT ON WITHDRAWN AND RECOVERED AMOUNTS, PENDING RECOVERIES AND IRRECOVERABLE AMOUNTS (ARTICLE 20(2)) 1. WITHDRAWALS AND RECOVERIES DEDUCTED FROM STATEMENTS OF EXPENDITURE DURING THE YEAR 20… (A) withdrawals ( 1 ) (B) recoveries ( 2 ) a b c d e f g h i Priority axis Total amount of expenditure paid by beneficiaries withdrawn ( 3 ) Corresponding public contribution withdrawn ( 4 ) Total amount of expenditure withdrawn relating to irregularities reported under Art. 28(1) of Regulation (EC) No 1828/2006 ( 5 ) Amount of corresponding public contribution withdrawn relating to irregularities reported under Art. 28(1) of Regulation (EC) No 1828/2006 ( 6 ) Public contribution recovered ( 7 ) Total amount of expenditure paid by beneficiaries ( 8 ) Amount of public contribution recovered relating to irregularities reported under Art. 28(1) of Regulation (EC) No 1828/2006 ( 9 ) Total amount of expenditure relating to irregularities reported under Art. 28(1) of Regulation (EC) No 1828/2006 ( 10 ) 1 2 3 4 … Total 2. PENDING RECOVERIES AS AT 31.12.20.. a b c d e f Priority axis Year of launch of recovery proceedings Public contribution to be recovered ( 11 ) Total amount of eligible expenditure paid by beneficiaries ( 12 ) Total amount of expenditure relating to irregularities reported under Art. 28(1) of Regulation (EC) No 1828/2006 ( 13 ) Amount of public contribution to be recovered relating to irregularities reported under Art. 28(1) of Regulation (EC) No 1828/2006 ( 14 ) 1 2007 2008 … 2 2007 2008 … 3 2007 2008 Total 3. IRRECOVERABLE AMOUNTS AS AT 31.12.20.. a b c d e f g h i j k Name of operation Priority axis Irregularity identification number if applicable ( 15 ) Year of launch of recovery proceedings Public contribution declared as irrecoverable ( 16 ) Total expenditure paid by beneficiaries declared as irrecoverable ( 17 ) Date of last payment of public contribution to beneficiary Date of establishment of irrecoverability Reason for irrecoverability Recovery measures taken including date of recovery order Indicate whether the Community share should be borne by the budget of the European Union (Y/N) ( 18 ) X 20.. Y 20.. Z 20.. Total ( 1 ) Part A) of the table (withdrawals) is completed relating to expenditure already declared to the Commission and which has been withdrawn from the programme following detection of the irregularity. In this case the tables 2 and 3 of this annex will not need to be completed. ( 2 ) Part B) of the table (recoveries) is completed relating to expenditure which was left for the time being in the programme pending outcome of recovery proceedings and which has been deducted following recovery. ( 3 ) This amount is the total amount of expenditure already declared to the Commission which was affected by irregularities and which has been withdrawn. ( 4 ) This column has to be completed where the contribution of the Funds is calculated with reference to public eligible expenditure. ( 5 ) This amount is the part of the amount in column b) which has been reported as irregular under the reporting procedures laid down in Article 28 of Regulation (EC) No 1828/2006. ( 6 ) This column has to be completed where the contribution of the Funds is calculated with reference to public eligible expenditure. ( 7 ) This is the amount of public contribution effectively recovered from the beneficiary. ( 8 ) This amount is the amount of expenditure paid by the beneficiary corresponding to the public contribution in column f). ( 9 ) This amount relates to the part of the amount in column f) which has been reported as irregular under the reporting procedures laid down in Article 28 of Regulation (EC) No 1828/2006. ( 10 ) This amount relates to the part of the amount in column g) which has been reported as irregular under the procedures laid down in Article 28 of Regulation (EC) No 1828/2006. ( 11 ) This is the public contribution subject to recovery proceedings at the level of the beneficiary. ( 12 ) This is the amount of the amount of expenditure paid by the beneficiary corresponding to the public contribution in column c). ( 13 ) This amount relates to the part of the amount in column d) which has been reported as irregular under the reporting procedures laid down in Article 28 of Regulation (EC) No 1828/2006. ( 14 ) This amount relates to the part of the amount in column c) which has been reported as irregular under the reporting procedures laid down in Article 28 of Regulation (EC) No 1828/2006. ( 15 ) This is the reference number attributed to the irregularity or other identification referred to in Article 14(3) of Regulation (EC) No 1828/2006. ( 16 ) This is the amount of public contribution paid by the beneficiary for which it was established that recovery could not be carried out or for which recovery is not expected to take place. ( 17 ) This amount is the amount of expenditure paid by the beneficiary corresponding to the public contribution in column (e). ( 18 ) Community share is calculated by applying the co-financing rate at the level of the priority axis either with reference to column (e) or (f) pursuant to Article 53(1)(a) or (b) of Regulation (EC) No 1083/2006."