Date of Cover Sheet: …………VerougstraeteNicolas392011-12-19T07:29:00Z2011-12-20T09:14:00Z2011-12-20T14:52:00Z610626057畅潲数湡䌠浯業獳潩n5014710514

Project

Grant Application Form

Submission date: XX/XX/XXXXX

Last update:

13/12/2011

These boxes are filled by the WBIF Project Financiers Group of the WBIF

Contribution Request number

WBX-XXX-XXX-XX

For submission to Project Financiers Group of:

XX/XX/2012

Proposal of the Project Financiers group:

Grant Contribution from WBIF:

from EC Budget:

from other funds:

Type of intervention:

WBIF Screening

(cf. Screening list in Annex 2)

WBIF Assessment

(cf. Assessment list in Annex 3)

PGAF and Annex 1 to

be filled by the submitter

Title of the Operation:

XXXXX

Beneficiary(

ies

)/ Country(

ies

)

Albania

Bosnia and Herzegovina

Croatia

, the

former

Yugoslav Republic of Macedonia

, Montenegro

, Serbia

, and

Kosovo (with a footnote reference to UNSCR 1244/1999 the first time it is mentioned in the document) are the mandatory names that must be used when referring to the Beneficiaries in this introductory section as well as in the text body of the application form.

XXXXX

(Interested) Lead IFI

ead IFI must

get

confirmed before submission.

XXXXX

Eligible Sector

Please see annex 1, point 2.

XXXXX

Sub-sector

XXXXX

DAC Sector

For guidance s

ee: www.oecd.org/dac/stats/data

XXXXX

DAC code

XXXXX

Geographical coverage

Borrower / Beneficiary(

ies

)

(contact points for both)

Project description

(description of the

planned

investment(s) and the present situation, including problems to overcome)

Outcome / Results to be achieved for the investment:

(specify the foreseen results, indicate

1. the economic

2. the social

the

environmental benefits produced by the investment

as well as the estimated number of direct beneficiaries)

Strategic justification:

(specify which strategy and/or investment plans both at national and regional level include the proposed project)

Can you describe how the project is in line with

- EU pre-accession strategy

- National strategy

-Other donors' strategy?

Additional comments on the project:

his part should focus on

constraints, partners/site availability, assumptions and risks appraisal etc

- provisional project chronology, including target date for loan signature

Description of the Grant use:

This part should focus on:

- what is concretely requested to be financed

and the expected outcomes

- how the use of this grant is linked to eventual other existing grants

Grant request justification

This part should focus on the value added of the grant:

-Why a grant contribution is needed for the Project completion?

ow will the grant help remove barriers and accelerate project completion?

ow urgent is this grant request and why?

Conformity with the eligibility checklist: summary

(cf. list in Annex 1)

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AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAD//2T==

Western Balkan

Investment Framework (WBIF)PAGE PAGE 6/ NUMPAGES 6

Financing Plan

Title of the Operation:

XXXXX

Type of Contribution

(type of grants)

The grant financing to a specific investment project (“Grant operation”) may take the form of

Technical assistance: financing technical assistance including preparatory work for eligible investment projects such as impact assessments, feasibility studies, detailed design, project supervision and targeted capacity building and implementation support.

Investment grants: direct grants for specific project components, as well as incentive schemes based on performance of implementing institutions.

Incentive payments to financial intermediaries.

Interest rates subsidies: provision of a lump-sum amount to ensure that the loan finance needed for the investment project can be made available at reduced interest rates.

Insurance

premia

: funding of insurance

premia

necessary to implement the investment projects.

EUR equivalent

In Project Currency

Curr

Total Investment

XXX

EUR

Sources of funding

Sources t

o be adapted case by case

Total (€ M)

Remarks (grants/loans)

WBIF grant request

Loan from IFIs

…

Beneficiary Contribution

EC Contribution IPA

Total Financing (€)

100%

Cost

Activities

(

possibly broken down

in phases)

Project

preparation

(

i.e

. FS, DD

…

)

Investment

(

i.e

works, supervision,

etc

)

…

Total activities

100%

Total Grant requested

Total Loan

equ

ired

Eligible Finance Institution Consortium

Lead

IFI

Contact person

Phone

XXX

Other Eligible

FI (EFI) member of the consortium

Contact person

Phone

XXX

Annex 1: Eligibility checklist

Yes

Operations covered by the WBIF benefit one or more of the following beneficiaries: Albania, Bosnia and Herzegovina, Croatia, the former Yugoslav Republic of Macedonia, Montenegro, Serbia and Kosovo under UNSCR 1244/1999.

Fall within one of the eligible sector:

Environment:

water supply, waste water treatment, sewage systems, solid waste and hazardous waste management, emission control etc.;

Energy:

renewable energy, interconnection systems, transmission, co-generation, hydro, and gas pipelines, etc.;

Energy efficiency and savings;

Transport:

railways and inland waterways including river ports, roads, seaports, airports, border facilities, inter modal terminals and urban transport;

Social:

schools and education centres, hospitals and health centres, social housing, reclusion centres and other public buildings;

SME, private and financial sector support

2bis

The project is not supported by the Regional Development Component of IPA

The project benefits public or private entities or entities with mixed public-private capital responsible for the provision, management, construction and negotiation of public utilities and services

All elements included under the activities covered by a WBIF grant

When calculating the eligible costs of a project that may benefit from grant financing or co-financing, the rules and procedures of the Commission, the partner IFIs and the EWBJF will apply. Eligibility of IFI Grant financing should be confirmed with co-financiers. According to the IPA Regulation the following expenditures are not eligible: a) taxes, including value added taxes (in principle); b) customs and import duties, or any other charges; c) purchase, rent or leasing of land and existing buildings; d) fines, financial penalties and expenses of litigation; e) operating costs (can be allowed on a case-by-case basis); f) second hand equipment; g) bank charges, cost of guarantees and similar charges; h) conversion costs, charges and exchange losses associated with any of the component specific euro accounts, as well as purely financial expenses; and

) contributions in kind. In addition, any leasing costs or depreciation costs are not eligible. In the case of revenue-generating projects, meaning a project involving an investment in infrastructure, which is subject to charges borne directly by users, the eligible cost is calculated according to a funding gap method deducting the value of the net revenue over a specific time from the value of the investment cost.

for the investment projects are in principle eligible for grant financing

The project is submitted by the Beneficiary, either via the NIPACs

NIPAC = National IPA Coordinator. The NIPAC is responsible for coordination of programming and monitoring the implementation of IPA in the Beneficiaries of the Western Balkans and

Turkey

. As IPA represent the biggest source of external aid and is linked to the progress and development needed in the EU accession process, and in line with the local ownership over donor funds and donor coordination as foreseen in the Paris declaration, the involvement of the NIPAC is of utmost importance for the effectiveness of the JGF and the WBIF.

or via the partner IFIs

The project is consistent with the EU Pre-Accession Strategy and relevant sector policies and national investment plans

Grant requests explicitly mention any complementarities or coherence with projects supported or planned for support under the IPA National Programmes (for implementation by the EU Delegations or by the Beneficiaries authorities) and/or other donors activities

The borrower/beneficiary intends to use the leverage of a loan through the Joint Lending Facility for this project

Grant operation will be consistent with the policies, rules and procedures of each source of funds (Commission, EIB, EBRD, CEB and EWBJF)

PFG Technical Advice and conclusionsAnnex 2: Screening

(coordinated by DG Enlargement)

PROJECT_CODE

How this project is supported by beneficiaries

and

NIPACs (National IPA Coordinators) as a priority

investment?

This part should also offer a technical advice on the

urgency and maturity of the grant requested

, on

the clarity of the proposed use

of grant

and

on the amounts requested

IPF_TA_COMMENT

How the project is consistent with national (sector) strategies, national investment plans and with the IPA priorities and the project potential for IPA support (not allocated via the JGF) or other donor funding?

COUNTRY_DESK_AND_EUD

_AND_DGREGIO

_COMMENT

How the project is consistent with

relevant

EU policies?

How the project is consistent with regional strategies and investment plans?

Is it the project presenting the appropriate mix of funding?

LINE_DG_

AND_ECFIN_

COMMENT

Conclusion

SCREENING_CONCLUSION

Annex 3: Assessment

As per

ToR

the Lead IFI has checked the following aspects:

Technical aspects, environmental and social standards, procurement, financial and economic profitability, credit risk, legal aspects.

Consistency with IFIs’ policies and procedures

Analysis and estimation of TA/grants needs

Financial structuring/identification of lending under the Joint Lending Facility (only IFIs)

Identification of lead IFI and possible mutual reliance

Link with project borrowers and promoters on technical and financial aspects

Exchange of information among Finance Institutions (e.g. pricing, conditionality)

(coordinated by le

d IFI)

PROJECT_CODE

Rationale for use of grant funds

, including assessment of project maturity and urgency

GRANT_FUNDS_COMMENT

Regional / Cross Border Impact

BORDER_IMPACT_COMMENT

Conformity with socio-environmental standards

ENVIRONMENT_COMMENT

Economic and Financial justification

, including assessment of TA/grants needs and leverage aspect

ECONOMIC_FINANCIAL_COMMENT

Capacity of Beneficiary institution

, including how the grant support will help capacity building

BENEFICIARY_COMMENT

If assessment has been done in consultation with beneficiary, indicate the contact person, institution and when consultation took place

BENEFICIARY

_CONT

ACT_COMMENT

Confirm Financial Plan, as shown above

in main text body

, is

valid &

correct. Insert

new/

revised plan

here

if necessary

CONFIRM_FINANCIAL_PLAN_COMMENT