ANNEX IIISupplementary provisions
ANNEX III REQUEST FOR PAYMENT AS MENTIONED IN ARTICLE 3(a) Text of image REQUEST FOR PAYMENT Upon adoption of Financing Decision, 6 months after the end date or confirmation of eradication of the disease, whichever is earlier To be adressed to: SANCO-CONSULT-G5@ec.europa.eu For the period from DD/MM/YY to DD/MM/YY Outbreak reference MS/Disease/Year Contact person for this request for payment: Telephone: E-mail address Direct cost — Compensation — Total amount (In euro, VAT excluded) Type of animals/products Quantity Sub-total: EUR — Direct cost — Operational costs — Total amount (In euro, VAT excluded) Slaughter/culling Cleaning, desinsectisation and disinfection Transport and destruction of feedingstuffs and equipment Purchase, storage, administration or distribution of vaccines Transport and disposal of carcasses Other essential costs (Article 8(1)(h) of Regulation (EU) No 652/2014) Sub-total: EUR — Text of image Indirect cost — Overhead 7 % — Total amount (In euro, VAT excluded) Overheads on direct costs, other than compensation (7 %) Sub-total: EUR — TOTAL EUR — Statement by the beneficiary this expenditure was actually incurred, accurately accounted for; the above costs correspond to the resources employed for the work and those resources were reasonable and necessary for the work; the costs were incurred and fall within the definition of eligible costs; all supporting documents relating to the expenditure are available for inspection; no other Union contribution was requested for this action and all revenue accruing from operations for this action is declared to the Commission; control procedures apply, in particular to verify the accuracy of the amounts declared, to prevent, detect and correct rregularities. Date: Signature: Name of responsible: