APPLICATION FORM
Call reference: GP/EFSA/BIOHAZ/2013/01
Call title: Relationship between seroprevalence in the main livestock species and presence of Toxoplasma gondii in meat
Restricted to the list adopted by EFSA Management Board according to article 36 of European Parliament and Council Regulation (EC) No 178/2002

Before completing this Application form, please read carefully:

  • CALL FOR PROPOSALS AND GUIDE FOR APPLICANTS
  • RULES ON ELIGIBILITY OF COSTS

Please note that this Application form has to be completed in all the parts following these instructions:
Text in blue background: only advice for applicants
Text in yellow background: text to be completed by the applicants
Text in white background must be kept in the final version of this Application form

The Application form has to be supported by all documents indicated under the Application Submission Completeness Checklist.

Incomplete application forms will not be accepted.

Table of Contents

1.PART 1 – APPLICATION FORM

1.1INFORMATION ON THE APPLICANT AND POTENTIAL PARTNERS

1.1.1IDENTITY

1.2INFORMATION ON THE PROJECT FOR WHICH THE GRANT IS REQUESTED

1.2.1DESCRIPTION OF THE PROJECT

1.3OTHER SOURCES OF EXTERNAL FINANCING OTHER THAN FINANCING FROM EFSA FOR APPLICANT AND PARTNERS (IN CASE OF CONSORTIUM)

1.3.1FUNDS CONFIRMED

1.3.2OTHER FUNDS REQUESTED, BEING APPLIED FOR OR AWAITING CONFIRMATION

1.4GRANT REQUESTED FROM EFSA

2.PART 2 – APPLICATION SUBMISSION COMPLETENESS CHECKLIST

PART 1 – APPLICATION FORM

INFORMATION ON THE APPLICANT AND POTENTIAL PARTNERS

IDENTITY

All this information has to be provided for the applicant and all potential partners of consortium. The information given here must be taken from official documents such as memorandum and articles of association or equivalent documents as indicated in the CALL FOR PROPOSALS AND GUIDE FOR APPLICANTS.

1.1.1.1APPLICANT - IDENTITY

Official name in full: XXXX

Short name or acronym:XXXX

Official legal form:XXXX

Legal representative of the applicant (he/she will sign the grant agreement in case of award): XXXX

Applicant’s official address:

  • Street:XXXX
  • Number:XXXX
  • Post code: XXXX
  • City: XXXX
  • Country: XXXX
  • Telephone:XXXX
  • Fax:XXXX
  • E-mail address:XXXX
  • Internet siteXXXX

Contact person responsible for this proposal:

  • Name: XXXX
  • Position: XXXX
  • Telephone: XXXX
  • Fax: XXXX
  • E-mail address: XXXX
1.1.1.2PARTNER 1 - IDENTITY

(if applicable) (repeat this part as many times as is required to include all members of consortia)

Official name in full: XXXX

Short name or acronym: XXXX

Official legal form:XXXX

Legal representative of the partner (he/she will sign the grant agreement or power of attorney in case of award):XXXX

Applicant’s official address:

  • Street: XXXX
  • Number: XXXX
  • Post code: XXXX
  • City: XXXX
  • Country: XXXX
  • Telephone: XXXX
  • Fax: XXXX
  • E-mail address: XXXX
  • Internet site XXXX

Contact person responsible for this proposal:

  • Name: XXXX
  • Position: XXXX
  • Telephone: XXXX
  • Fax: XXXX
  • E-mail address: XXXX

INFORMATION ON THE PROJECT FOR WHICH THE GRANT IS REQUESTED

DESCRIPTION OF THE PROJECT

Title: : Relationship between seroprevalence in the main livestock species and presence of Toxoplasma gondii in meat

Specific objective(s) of the project:

  • describe in detail how the project achieves the objectives of the Call

XXXX

Detailed description of the project

  • describe in detail how the project guarantees an excellent level of scientific output, how the project provides significant and sustainable impact and added value to the existing knowledge, the methodology to be applied and all the activities/tasks to be carried out in order to achieve the objectives of the project, the expected deliverables/results of the project for each stage

XXXX

In particular, the applicant must describe in detail the proposed approach including the following information:

1)A detailed description of the methodology for carrying out the extensive literature search and review, with particular details on methodologies proposed for the:

  1. literature search (i.e. the databases that will be consulted, screening criteria used in the search, how many experts will screen titles, abstracts and full text,, whether the examination of the studies will be done independently by each of the reviewers; how potential disagreements on study eligibility will be solved; and other related issues;)
  2. assessment and comparison among studies and various types of information (e.g. level of evidence of individual studies) by using structured tables and summaries in narrative text; and criteria used to generate the structured tables summarising the data from the selected literature.

XXXX

2)A detailed preliminary[1] description of the methodology and the experimental design of the proposed experimental studies, with particular details on the following:

  1. the details of the experimental methods the applicant intends to apply to carry out the study;
  2. the meat-producing animal species to be included in the study;
  3. the sampling scheme (i.e. the number of farms, slaughterhouses, animals, samples) that will be included in the experimental study. The farms selected to provide animals for testing in the slaughterhouse should represent the range and diversity typically found in the EU MSs in order to allow the risk factor analysis. The reasons for selecting these farms should be stated. The number of samples to be taken and the number of farms to be included in the experimental study should be specified clearly in the proposal. The minimum and/or maximum numbers being left to the discretion of the applicant. The number of samples proposed for the different species should be sufficiently large to ensure that subsequent statistical analysis provides as broad and in-depth a study as possible; and
  4. the statistical analysis which will be employed to analyse the data should also be described in detail in the proposal.

XXXX

Description of the organisation / implementation of the project

  • 1) describe in detail the quality control mechanisms to be put in place to guarantee high quality of deliverables.

XXXX

  • 2) describe in detail the measures put in place in order to assure a sound project management, including the way the various tasks are distributed within the team; internal communication inside the project team, and communication with EFSA;

XXXX

  • 3) Provide clear indication of the timelines for the completion of the project’s tasks providing detailed milestones for each task (e.g. via a project Gantt chart) as well as a description of the risks that might be foreseen per each individual task, and a description of the measures put in place to assure that the deadlines for providing deliverables are met. In addition, a contingency plan in case deviations from the project programme is required.

XXXX

Indication of work to be subcontracted

  • justify in detail any requested sub-contracting, including the amounts estimated; This information must be in compliance with the data introduced in the Estimated Budget (Part A.5):

XXXX

OTHER SOURCES OF EXTERNAL FINANCING OTHER THAN FINANCING FROM EFSA FORAPPLICANT AND PARTNERS (IN CASE OF CONSORTIUM)

The data below are to be provided for each external public sector body contribution to the project

FUNDS CONFIRMED

Official name in full: XXXX

Official legal form: XXXX

Official address: XXXX

Activities: XXXX

Person responsible within the contributing public sector body that has signed the commitment letter (name/first name, title or position): XXXX

Amount of funding which the contributing public sector body undertakes to provide for the project: XXXX

Any preallocation of these funds: XXXX

Any conditions or reservations: XXXX

OTHER FUNDS REQUESTED, BEING APPLIED FOR OR AWAITING CONFIRMATION

Organisation concerned: XXXX

Official address: XXXX

Activities: XXXX

Amount requested: XXXX

Any preallocation of these funds: XXXX

Any conditions or reservations: XXXX

GRANT REQUESTEDFROM EFSA

Estimated total costs of the project in EURO (C=A+B) / XXXX
Estimated total ineligible costs of the project in EURO (A) / XXXX
Estimated total eligible costs of the project in EURO (B) / XXXX
Estimated total eligible direct costs of the project in EURO / XXXX
Amount of grant requested from EFSA in EURO / XXXX

The applicant commits to inform EFSA as soon as possible of any changes of operational or financial nature, both in the applicant’s structure (and also partners` structure in case of consortium), which might affect him/them or the project covered by the grant application.

The applicants confirms that both the applicant and possible partners comply with the essential condition of being on the list of competent organisations designated by the Member States in accordance with Art 36 of Regulation (EC) 178/2002 and Commission Regulation (EC) 2230/2004. This list is regularly updated by EFSA Management Board. You may consult the list of competent organization at this link:

Signature of the legal representative of the applicant:

Signature: XXXX

Place:XXXX

Date (day/month/year):XXXX

Name of the legal representative of the applicant: XXXX

Stamp of the applicant organisation (if available): XXXX

PART 2 – APPLICATION SUBMISSION COMPLETENESS CHECKLIST

  • The below checklist is designed to help the applicants to ensure that all requested documentation is provided to EFSA.
  • The application must be submitted in line with guidelines described in the Call for Proposals and Guide for Applicants.
  • This checklist should be signed and included in the Application Form.
  • Please tick  in the boxes provided if the document is attached to the application.

The application submissionmust contain one original unbound signed paper version and one electronic version (on CD Rom or USB key, in PDF format)of all the following documents:

 / Completed, signed/dated Application Form
 / This checklist signed and dated.
 / Legal Entity Form and supporting documents to be provided for the Applicant and for each possible partner.
 / FINANCIAL IDENTIFICATION FORM to be provided for the Applicant.
 / THE DECLARATION OF HONOUR - to be provided for the Applicant and for each possible partner.
 / Applicable only if Applicant and/or each possible partner are not Public Bodies: SIMPLIFIED FINANCIAL STATEMENT
 / CURRICULUM VITAE of the project manager/s and scientific staff to be involved in the project, including for each member a brief description of the expertise and a list of publications relevant to the project. If available please provide a description of any project(s) carried out in the past that is/are similar to the subject matter of this Call.
 / Applicable only in case of consortium: PARTNERSHIP STATEMENT - defining the technical and financial involvement of each member of consortium (applicant and partners) signed individually by each of the member of consortium (applicant and partners).
 / Applicable only when the project involves other sources of funding than EFSA grant and contributions from applicant and potential partners: LETTER OF COMMITMENT signed by other contributing public sector body; the letter must express confirmation of commitment of the public sector body to financially contribute to the project - to be provided for the Applicant and for each possible partner
 / ESTIMATED BUDGET - one common Estimated Budget for the project covering all costs and incomes
It is important to ensure that:
 / The Applicationform is formulated in one of the official languages of the EU (with a preference for the use of English, French or Italian).
 / TheApplicationform is signed/dated by legal representative of the applicant
 / The Application form is perfectly legible in order to rule out any ambiguity.

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[1]It is expected that this study design will be updated following the extensive literature review.