Core of Model Grant Agreement

IMI_GB_DEC_2011_11_1_Annex

IMI JOINT UNDERTAKING MODEL GRANT AGREEMENT

ANNEX IV - FORM B

REQUEST FOR ACCESSION OF A NEW PARTICIPANT TO THE GRANT AGREEMENT

(to be filled in by each new legal entitywilling to become a participant)

[full name and legal form of new participant], represented for the purpose hereof by [(name of legal representative), (function) [and/or (name of legal representative), (function)],or her/his/their authorised representative established in (full address/city/state/province/country)],acting as its legal authorised representative, hereby requests to become a participant ("participant no.") to grant agreementNo …… (relating to project [title]) concluded between the IMI JU and [name of thecoordinator] and accepts, in accordance with the provisions of the aforementioned grantagreement, all the rights and obligations of a participant starting on [date], should the IMI JUnot oppose this request within 30 days of its receipt.

[name of the coordinator and legal form (acronym) established in (full address/ city/state/province/country)], represented for the purpose hereof by [(name of legal representative), (function) [and/or (name of legal representative), (function)], or her/his/their authorised representative established in (full address/city/state/province/country)] acting as its legal authorised representative, hereby certifies ascoordinatorunder this grant agreement No…… (relating to project [title]) that the consortium proposes and agrees to the accession of [full name and legal form of new participant] to the aforementioned grant agreement as participant starting on the abovementioneddate.

Enclosures:

-Grant Agreement Preparation Forms duly completed and signed by the new participant.

-Modified Annex I to the grant agreement describing the work to be performed by the new participant.

-Justification for selection of this/these participant(s).

Done in 3 originals, of which one shall be kept by the coordinator and one by [name of new participant], the third being sent to the IMI JU by the coordinator in accordance with Articles 8 and II.35 of the grant agreement.

Name of Legal Entity [full name of the new participant]

Name of legal representative(s): (written out in full)

Signature of legal representative(s):

Date:

Stamp of the organisation

Name of Legal Entity [full name of the coordinator]

Name of legal representative: (written out in full)

Signature of legal representative:

Date:

Stamp of the organisation

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IMI Grant Agreement [insert NUMBER]

[insert ACRONYM]