ANNEX IISupplementary provisions
ANNEX II Annex VI is replaced as follows: ‘ANNEX VI Model for the payment application including additional information concerning financial instruments PAYMENT APPLICATION EUROPEAN COMMISSION Fund concerned ( 1 ) : <type="S" input="S" > ( 2 ) Commission reference (CCI): <type="S" input="S"> Name of operational programme: <type="S" input="G"> Commission Decision: <type="S" input="G"> Date Commission Decision: <type="D" input="G"> Payment application number: <type="N" input="G"> Date of submission of the payment application: <type="D" input="G"> National reference (optional): <type="S" maxlength="250" input="M"> Please specify the type of the payment application: An interim payment application, in accordance with Article 131 of Regulation (EU) No 1303/2013 <radio button> A final application for interim payment in accordance with Article 135(2) of Regulation (EU) No 1303/2013 <radio button> According to Article 135 of Regulation (EU) No 1303/2013, this payment application refers to the accounting period: From ( 3 ) <type="D" input="G"> until: <type="D" input="G"> Expenditure broken down by priority and category of regions as entered into the accounts of the certifying authority ( 4 ) (Including programme contributions paid to financial instruments (Article 41 of Regulation (EU) No 1303/2013) and advances paid in context of State aid (Article 131(5) of Regulation (EU) No 1303/2013)) Priority Calculation basis (public or total) Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations Total amount of public expenditure incurred in implementing operations (A) (B) (C) Priority 1 Less developed regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> YEI ( 5 ) <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 2 Less developed regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> YEI <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 3 Less developed regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 4 YEI ( 5 ) <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Totals Less developed regions <type="Cu" input="G"> <type="Cu" input="G"> Transition regions <type="Cu" input="G"> <type="Cu" input="G"> More developed regions <type="Cu" input="G"> <type="Cu" input="G"> Outermost regions and Northern sparsely populated regions <type="Cu" input="G"> <type="Cu" input="G"> YEI <type="Cu" input="G"> <type="Cu" input="G"> Grand Total <type="Cu" input="G"> <type="Cu" input="G"> The model is automatically adjusted on basis of the CCI or other elements of the programme. As an example, in case of programmes not including categories of regions (Cohesion Fund, ETC, EMFF, ENI and IPA contributions to ETC, YEI dedicated operational programme without technical assistance, ERDF REACT-EU, ESF REACT-EU, YEI REACT-EU ( 6 ) if applicable) the table shall look as follows: Priority Calculation basis (public or total) ( 7 ) Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations Total amount of public expenditure incurred in implementing operations (A) (B) (C) Priority 1 <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 2 <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 3 <type="S" input="G"> <type="Cu" input="M"> <type="Cu" input="M"> Grand Total <type="Cu" input="G"> <type="Cu" input="G"> CERTIFICATE By validating this payment application the Certifying Authority certifies that the responsibilities foreseen in points (a), (d), (e), (f), (g) and (h) of Article 126 of Regulation (EU) No 1303/2013 are fulfilled and requests the payment of the amounts as mentioned below. Representing the Certifying Authority: <type="S" input="G"> APPLICATION FOR PAYMENT FUND AMOUNTS Less developed regions Transition regions More developed regions Outermost regions and Northern sparsely populated regions (A) (B) (C) (D) <type="S" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> YEI ( 8 ) <type="Cu" input="G"> ERDF REACT-EU <type="Cu" input="G"> ESF REACT-EU <type="Cu" input="G"> YEI REACT-EU ( 9 ) <type="Cu" input="G"> The model is automatically adjusted on basis of the CCI or other elements of the programme. As an example, in case of programmes not including categories of regions (Cohesion Fund, ETC, EMFF, ENI and IPA contributions to ETC, YEI dedicated operational programme without technical assistance, ERDF REACT-EU, ESF REACT-EU, YEI REACT-EU, if applicable) the table shall look as follows: FUND AMOUNT <type="S" input="G"> <type="Cu" input="G"> The payment will be made on the following bank account: Designated body <type="S" maxlength="150" input="G"> Bank <type="S" maxlength="150" input="G"> BIC <type="S" maxlength="11" input="G"> Bank account IBAN <type="S" maxlength="34" input="G"> Holder of account (where not the same as the designated body) <type="S" maxlength="150" input="G"> ‘APPENDIX 1 Information on programme contributions paid to financial instruments as referred to in Article 41 of Regulation (EU) No 1303/2013 and included in the payment applications (cumulative from the start of the programme) ( 10 18 ) Programme contributions paid to financial instruments included in payment applications Amounts paid as eligible expenditure in the meaning of Article 42(1)(a), (b) and (d) of Regulation (EU) No 1303/2013 ( 11 19 ) (A) (B) ( 12 20 ) (C) (D) ( 12 20 ) Priority ( 13 21 ) Total amount of programme contributions paid to financial instruments Amount of corresponding public expenditure Total amount of programme contributions effectively paid, or, in the case of guarantees, committed, as eligible expenditure in the meaning of Article 42(1)(a), (b) and (d) of Regulation (EU) No 1303/2013 ( 14 ) Amount of corresponding public expenditure Priority 1 Less developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> YEI ( 15 ) <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 2 Less developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> YEI <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 3 Less developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> YEI <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 4 YEI ( 16 ) <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Totals Less developed regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> Transition regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> More developed regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> Outermost regions and Northern sparsely populated regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> YEI <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> Grand Total <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> The model is automatically adjusted on basis of the CCI or other elements of the programme. As an example, in case of programmes not including categories of regions (Cohesion Fund, ETC, EMFF, ENI and IPA contributions to ETC, YEI dedicated operational programme without technical assistance, ERDF REACT-EU, ESF REACT-EU, YEI REACT-EU, if applicable) the table shall look as follows: Programme contributions paid to financial instruments included in payment applications Amounts paid as eligible expenditure in the meaning of Article 42(1)(a), (b) and (d) of Regulation (EU) No 1303/2013 ( 17 ) (A) (B) (C) (D) Priority Total amount of programme contributions paid to financial instruments Amount of corresponding public expenditure Total amount of programme contributions effectively paid, or, in the case of guarantees, committed, as eligible expenditure in the meaning of Article 42(1)(a), (b) and (d) of Regulation (EU) No 1303/2013 ( 17 ) Amount of corresponding public expenditure Priority 1 <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 2 <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 3 <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Grand Total <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> ‘APPENDIX 2 Advances paid in the context of State aid (Article 131(5) of Regulation (EU) No 1303/2013) and included in the payment applications (cumulative from the start of the programme) Priority Total amount paid from the operational programme as advances ( 10 18 ) Amount which has been covered by expenditure paid by beneficiaries or, where Member States have decided that the beneficiary is the body granting the aid pursuant to point (a) of Article 2(10) of Regulation (EU) No 1303/2013, by the body receiving the aid, within three years of the payment of the advance Amount which has not been covered by expenditure paid by beneficiaries or, where Member States have decided that the beneficiary is the body granting the aid pursuant to point (a) of Article 2(10) of Regulation (EU) No 1303/2013, by the body receiving the aid, and for which the three year period has not yet elapsed (A) (B) (C) Priority 1 Less developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> YEI ( 11 19 ) <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 2 Less developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> YEI <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 3 Less developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Transition regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> More developed regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> YEI <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 4 YEI ( 12 20 ) <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Totals Less developed regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> Transition regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> More developed regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> Outermost regions and Northern sparsely populated regions <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> YEI <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> Grand Total <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> The model is automatically adjusted on basis of the CCI or other elements of the programme. As an example, in case of programmes not including categories of regions (Cohesion Fund, ETC, EMFF, ENI and IPA contributions to ETC, YEI dedicated operational programme without technical assistance, ERDF REACT-EU, ESF REACT-EU, YEI REACT-EU, if applicable) the table shall look as follows: Priority Total amount paid from the operational programme as advances ( 13 21 ) Amount which has been covered by expenditure paid by beneficiaries within 3 years of the payment of the advance Amount which has not been covered by expenditure paid by beneficiaries and for which the 3 year period has not yet elapsed (A) (B) (C) Priority 1 <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 2 <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Priority 3 <type="Cu" input="M"> <type="Cu" input="M"> <type="Cu" input="M"> Grand Total <type="Cu" input="G"> <type="Cu" input="G"> <type="Cu" input="G"> ’ ( 1 ) If a programme concerns more than one fund, application for payment should be sent separately for each of them. Irrespective of the way YEI is implemented (dedicated OP, specific priority axis or part of a priority axis), expenditure related to YEI activities will always be declared under an ESF payment application and will therefore cover both YEI specific allocation and ESF corresponding support. ( 2 ) Legends: type: N = Number, D = Date, S = String, C = Checkbox, P = Percentage, B = Boolean, Cu = Currency input: M = Manual, S = Selection, G = Generated by system ( 3 ) First day of the accounting year, automatically encoded by the IT system. ( 4 ) Tables in this Annex provide for the split of the REACT-EU resources (Article 92a of Regulation (EU) No 1303/2013) where necessary, i.e. ERDF REACT-EU, ESF REACT-EU and YEI REACT-EU. ( 5 ) The YEI is implemented through a dedicated priority as referred to in Article 18 of Regulation (EU) No 1304/2013. ( 6 ) Tables in this Annex provide for the split of the REACT-EU resources (Article 92a of Regulation (EU) No 1303/2013) where necessary, i.e. ERDF REACT-EU, ESF REACT-EU and YEI REACT-EU. ( 7 ) For the EMFF cofinancing applies only on "Total eligible public expenditure". Therefore, in case of EMFF, the calculation base in this model will automatically be adjusted to "Public". ( 8 ) Covers the specific allocation for the YEI and the corresponding ESF support. ( 9 ) Covers the specific allocation for the YEI REACT-EU and the corresponding ESF REACT-EU support. ( 10 ) For EAFRD (including the European Union Recovery Instrument) included in the quarterly declaration of expenditure. ( 11 ) At closure, the eligible expenditure shall respect the provisions of Article 42(1), (2) and (3) of Regulation (EU) No 1303/2013. ( 12 ) To be noted that due to the specificity of the EAFRD, the values in columns (B) and (D) are the same as those in columns (A) and (C) respectively. ( 13 ) For EAFRD Measure Code. ( 14 ) See footnote 49. ( 15 ) The YEI is implemented through part of a priority as referred to in Article 18 of Regulation (EU) No 1304/2013. Covers the specific allocation for the YEI and the corresponding ESF support. ( 16 ) The YEI is implemented through a dedicated priority as referred to in Article 18 of Regulation (EU) No 1304/2013. Covers the specific allocation for the YEI and the corresponding ESF support. ( 17 ) See footnote 49. ( 18 ) This amount is included in the Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations as mentioned in the payment application. As state aid is by nature public expenditure, this total amount is equal to public expenditure. ( 19 ) The YEI is implemented through part of a priority as referred to in Article 18 of Regulation (EU) No 1304/2013. Covers the specific allocation for the YEI and the corresponding ESF support. ( 20 ) The YEI is implemented through a dedicated priority as referred to in Article 18 of Regulation (EU) No 1304/2013. Covers the specific allocation for the YEI and ESF corresponding support. ( 21 ) This amount is included in the Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations as mentioned in the payment application. As state aid is by nature public expenditure, this total amount is equal to public expenditure.