CommonProposal

ForKorea-Czech Bilateral Co-fundingR&D Project

Pleasenotethattheinformationprovidedwillbetakenintoaccountwhenevaluatingtheprojectproposalsubmitted by partner institution/enterprise tothe5thpublic call ofthe DELTA programmeofthe Technology Agencyofthe Czech Republic andto theJoint Call forProposalsfor Korea-Czech Bilateral Co-funding R&D Projects.

PrincipalApplicant / LeadOrganizationfromthebothsidesshallcompletethisCommonProposalin collaboration and submiteach to therespectiveagencywhensubmittingtheproposalpackage.

Project Title:
Project Duration: Nmonths / *TotalEstimated Project Cost: USDnnn,nnn
**Project number (on the Czech side): / ***Project number (on theKoreanside):

* Totalestimatedcostsincluding KIAT and TA CR support and privateresourcesofallparticipants

**Willbegenerated by the TA CR informationsystem

*** To beprovided by KIAT; leaveitblank.

  1. Affidavit

OrganizationslistedunderConsortiumPartnershereinbelow(collectivelyreferred to as the „consortium“) herebydeclare and confirm as follows:

•Theconsortiumintends to collaborate on theabovementioned R&D project.

•No organization in theconsortiumis in liquidation and insolvencyorimpendingbankruptcyis not beingdealtwith ininsolvencyproceedings.

•No organization in theconsortiumis in financialdifficulty.

ConsortiumPartners

1a) PrincipalApplicant/ LeadOrganization
(on the Czech side)
Nameofinstitution/enterprise:
Address:
Phone:
Fax:
Website:
Contact Person
Name:
Position:
Division/Department:
Phone (direct):
Email: / 1b) PrincipalApplicant/ LeadOrganization
(on theKoreanside)
Nameofinstitution/enterprise:
Address:
Phone:
Fax:
Website:
Contact Person
Name:
Position:
Division/Department:
Phone (direct):
Email:
2a) ParticipatingOrganization
(on the Czech side)
Nameofinstitution/enterprise:
Address:
Phone:
Fax:
Website:
Contact Person
Name:
Division/Department:
Phone (direct):
Email: / 2b) ParticipatingOrganization
(on theKoreanside)
Nameofinstitution/enterprise:
Address:
Phone:
Fax:
Website:
Contact Person
Name:
Division/Department:
Phone (direct):
Email:
3a) (add more as necessary) / 3b) …
  1. Finance

1a) TotalProject BudgetofthePrincipalApplicant (on the Czech side) – USD

Nameofinstitution/enterprise:

Indicator / 2017* / 2018 / 2019 / Total
Costs
Support from TA ČR
Privatesources

*Pleaseleaveblank.

Ifthegovernmentcontributiondoes not coverallprojectcosts, howwillyou finance the rest ofprojectcosts (own profit ofthecompany, bank loan, …)? (pleasespecifyamounts and sourcesoffinancingoftheproject)

1b) TotalProject Budget ofthePrincipalApplicant (on theKoreanside) – USD

Nameofinstitution/enterprise:

Indicator / 2017 / 2018 / 2019 / Total
Costs
Support from KIAT
Privatesources

Ifthegovernmentcontributiondoes not coverallprojectcosts, howwillyou finance the rest ofprojectcosts (own profit ofthecompany, bank loan, …)? (pleasespecifyamounts and sourcesoffinancingoftheproject)

2a) TotalProject Budget oftheParticipatingOrganization (on the Czech side) – USD

Nameofinstitution/enterprise:

Indicator / 2017* / 2018 / 2019 / Total
Costs
Support from TA ČR
Privatesources

*Pleaseleaveblank.

Ifthe support does not coverallprojectcosts, howwillyou finance the rest ofprojectcosts (own profit ofthecompany, bank loan, …)? (pleasespecifyamounts and sourcesoffinancingoftheproject)

2b) TotalProject Budget oftheParticipatingOrganization (on theKoreanside)- USD

Nameofinstitution/enterprise:

Indicator / 2017 / 2018 / 2019 / Total
Costs
Support fromKIAT
Privatesources

Ifthe support does not coverallprojectcosts, howwillyou finance the rest ofprojectcosts (own profit ofthecompany, bank loan, …)? (pleasespecifyamounts and sourcesoffinancingoftheproject)

3a) a 3b) add more as necessary

  1. Resumé oftheproject
  1. Project Description

[Provide a descriptiveoverviewoftheproposedproject: projectaims/objectives, descriptionofresearchactivity, and expectedoutcomes. Alsospecifyexpectedoutcomesachieved by each participant.]

  1. RolesofeachLeadOrganization and ParticipatingOrganization

[Provide in a tabularformwhatactivitieseachorganizationintend to perform. Suggestedcolumnheadings: Task no, TaskName, Description, Deliverables]

  1. ImplementationPath

[Describetheimplementationplanfortheresultofthe R&D project such as commercialization, industrymemberutilization, etc.]

  1. Basisforcooperation

[Why do youwant to cooperate on theabovementionedproject?]

  1. IntellectualPropertyRights

[Howwillthe IPR related to theprojectbedealthwith? Whowillownthe IPR to theprojectresults? Describehowtherights to practicetheprojectdeliverables (bothtangible and intangible) willbeused.]

  1. Statutoryrepresentative/memberof a statutory body/representativewithauthorization to sign on behalfoftheorganization (according to thecommercialorotherregister).

(signature) (Date)
PrincipalApplicant on the Czech side / (signature) (Date)
PrincipalApplicant on theKoreanside
(PrintName)
(Position)
(NameofOrganization) / (PrintName)
(Position)
(NameofOrganization)
(signature) (Date)
PaticipationOrganization
on the Czech side / (signature) (Date)
PaticipationOrganization
on theKoreanside
(PrintName)
(Position)
(NameofOrganization) / (PrintName)
(Position)
(NameofOrganization)

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