MINISTRY FOR FINANCE AND EMPLOYMENT
PARLIAMENTARY SECRETARIAT FOR EUROPEAN FUNDS
Investing in Skills -
Request for Reimbursement - Call 2
Beneficiary Name (type the Legal Name of the entity as per Grant Agreement)
Grant Agreement Reference
Grant Agreement Date (DD MM YYYY)
Category A - External Trainers' Costs
Enter the total eligible training hours claimed as per attendance sheets and cappings indicated in the IIS Guidance Notes. Attendance sheets should be endorsed by both the trainer/s and the trainee/s.
Training Hours being Claimed
Number of Trainees
For Jobsplus use
For Treasury use
Training Hours being Claimed
Number of Trainees
For Jobsplus use
For Treasury use
Training Hours being Claimed
Number of Trainees
For Jobsplus use
For Treasury use
Operational Programme II - European Structural and Investment Funds 2014-2020 “Investing in human capital to create more opportunities and promote the wellbeing of society” Aid part-financed by the European Social Fund
Co-financing rate: 80% European Union; 20% National Funds
For Jobsplus use
MINISTRY FOR FINANCE AND EMPLOYMENT
PARLIAMENTARY SECRETARIAT FOR EUROPEAN FUNDS
Category B - Trainees’ Personnel Costs
Total number of trainees
For Jobsplus use
For Treasury use
Total wage costs as per Trainee (Value)
For Jobsplus use
For Treasury use
For Jobsplus use
For Treasury use
Category C - Trainers’ & Trainees’ Flight Expenses
Journey
Pax
Rate
Value
For Jobsplus use
For Treasury use
Journey
Pax
Rate
Value
For Jobsplus use
For Treasury use
Journey
Pax
Rate
Value
For Jobsplus use
For Treasury use
Categories A to C total amount (net of VAT)
For Treasury use
Correction on the Total Amount of 'Categories A to C' (if applicable)
For Jobsplus use
For Treasury use
% Co-financing rate as per Grant Agreement
For Jobsplus use
For Treasury use
Categories A to C co-financing amount
For Jobsplus use
For Treasury use
Maximum eligible public financing as per Grant Agreement
For Jobsplus use
For Treasury use
Amount previously paid
For Jobsplus use
For Treasury use
Training Aid payable in this Request in terms of Article 3 of the Grant Agreement
Total Value
For Jobsplus use
For Treasury use
"1. I hereby declare that the information herein is to the best of my knowledge true and correct, and the expenditure declared above was incurred in line with the Grant Agreement (GA) and Annexes thereto, and in compliance with the Guidance Notes governing the Investing in Skills.
2. I confirm and accept that for all intents and purposes, I am the legal and authorised person appointed by the entity to act on behalf of the Beneficiary for the purpose of this scheme and will be held fully and personally responsible both towards Jobsplus and the Beneficiary for ascertaining such authority.
3. I hereby declare that no funds invested in the Project by the Undertaking, NGO or Social Partner are of illicit origin, including products of money laundering or linked to the financing of terrorism.
4. I declare that the principles of Community rules and National regulations were followed unconditionally, in the spirit of good governance and transparency, and that such expenditure was never claimed beforehand through other sources. Besides, the undersigned is not aware of any irregularities.
5. I declare that the undertaking is not bankrupt or in the process of being wound up; its affairs are not being administered by the court, it has not entered into an arrangement with creditors or has no suspended business activities or is not in any analogous situations arising from a similar procedure under national law and regulations. Furthermore, the undertaking is not subject to proceedings for a declaration of bankruptcy, for an order for compulsory winding or administration by the court for an arrangement with creditors, or of any other similar proceedings under national laws or regulations.
6. I certify that the information provided above is accurate and complete to the best of my knowledge and belief. I understand that any misleading information may lead to the undertaking being ineligible to receive funding besides being subject to any other legal proceedings or other actions against the undertaking. If any activity is in breach of the GA or Regulations thereto, I agree to repay, by simple demand, all funds or part thereof.
7. I confirm that my bank details have not changed since submitting my last Financial Identification form (TR-S/9) as per Investing in Skills Guidance Notes.
8. I understand that it is my responsibility to declare any significant changes to the eligible activity(ies) in line with the GA and European Social Fund Regulations.
9. I hereby authorise Jobsplus and other relevant stakeholders to process the personal information provided in this form in accordance with the Data Protection Act, Cap 440 of the Laws of Malta and the General Data Protection Regulation (EU/679/2016).
10. I hereby declare, accept and confirm that in the operation benefiting this grant, the Undertaking has in place the necessary safeguards to prevent any form of discrimination based on sex, racial or ethnic origin, religion or belief, age, disability or sexual orientation as referred in terms of Chapter 452 and Chapter 456 of the Laws of Malta.
11. Having read and understood all of the above statements and conditions, I also understand that failure to adhere to any one or more of the above will render the undertaking ineligible for reimbursement and subject to recovery of funds had the funds been paid already.
12. Through this declaration the undersigned confirms that SSC (Social Security Contributions) in respect of trainees claimed in this reimbursement request have been paid in full.
13. I understand that applicants that are subject to an outstanding recovery order following a previous Commission decision declaring an aid illegal and incompatible with the internal market, will not be eligible to apply for assistance under this scheme.
14. I hereby declare, accept and confirm, that the operation, where applicable will ensure the preservation, protection and improvement of the quality of the environment and aims at promoting sustainable measures at operation level."
Name and Surname of the Contact / Delegated Person
_________________________________________________
Signature of the Contact / Delegated Person