Contracting authority: European Commission

Climate for Cities (C4C) in the Southern Neighbourhood

Annex A.1 – Grant application form - Concept note

Budget line: 22.04.01.02

Reference:
EuropeAid/170901/DH/ACT/Multi

Deadline for submission1 of concept notes:

31/03/2021 at 12:00 (Brussels date and time)
(in order to convert to local time click here2)

Title of the action:

Name of the lead applicant
Nationality of the lead applicant 3

Dossier No
(for official use only)

1 Online submission via PROSPECT is mandatory for this call for proposals (see section 2.2.2 of the guidelines). In
PROSPECT all dates and times are expressed in Brussels time. Applicants should note that the IT support is open
from Monday to Friday 08:30 to 18:30 Brussels time (except for public holidays).
2 An example of a time converter tool available online: http://www.timeanddate.com/worldclock/converter.html
3 An organisation’s statutes must show that it was established under the national law of the country concerned and
that the head office is located in an eligible country. Any organisation established in a different country cannot be
considered an eligible local organisation. See the footnotes to the guidelines for the call.

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 NOTICE

If processing your reply to the call for proposals involves the recording and processing of personal
data (such as names, contact details and CVs), they will be processed 4 solely for the purposes of
the management and monitoring of the calls for proposals and of the contract by the data
controller without prejudice to possible transmission to the bodies in charge of monitoring or
inspection tasks in application of EU law. In addition, as the contract relates to an external action
in Partner Countries outside the EU and as the EU, represented by the European Commission, is
acting as contracting authority on behalf and for the benefit of the Partner Countries, transmission
of personal data may occur to the Partner Country, solely for the purpose of complying with its
obligations under the applicable legislative framework and under the financing agreement
concluded between the EU and the Partner Country with regard to this grant award procedure.
Details concerning processing of your personal data are available on the privacy statement at
http://ec.europa.eu/europeaid/prag/annexes.do?chapterTitleCode=A 5
In cases where you are processing personal data in the context of participation to a grant award
procedure (e.g. contact details of legal representatives of co-applicants, CVs) and/or of the
implementation of a contract you shall accordingly inform the data subjects of the details of the
processing and communicate the above mentioned privacy statement to them.
The controller of call for tenders is the head of contracts and finance unit R4 of DG
Neighbourhood and Enlargement Negotiations.

4 Pursuant to Regulation (EU) 2018/1725 of the European Parliament and of the Council of 23 October 2018 on the
protection of natural persons with regard to the processing of personal data by the Union institutions, bodies, offices
and agencies and on the free movement of such data, and repealing Regulation (EC) No 45/2001 and Decision No
1247/2002/EC, OJ L 205 of 21.11.2018, p. 39.
5 This link will lead you to the "EuropeAid privacy statement" published in the Practical Guide General Annexes
(see Annexe A13).
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 Table of contents

1 CONCEPT NOTE...................................................................................................................4

1.1. Summary of the action......................................................................................................4

1.1.1. Fill in the table below:...........................................................................................................4

1.2. Description of the action: cover all the 5 points in the instructions: (max 2 page)......4

1.3. Relevance of the action (max 3 pages).............................................................................5

1.3.1. Relevance to the objectives/sectors/themes/specific priorities of the call for proposals.........5
1.3.2. Relevance to the particular needs and constraints of the target country/countries, region(s)
and/or relevant sectors (including synergy with other EU initiatives and avoidance of duplication).. .5
1.3.3. Describe and define the target groups and final beneficiaries, their needs and constraints,
and state how the action will address these needs................................................................................5
1.3.4. Particular added-value elements.............................................................................................5

1.4. Lead applicant, (co-applicants and affiliated entities, if any)........................................6

1.5. Project details.....................................................................................................................7

2 DECLARATION BY THE LEAD APPLICANT..................................................................8

INSTRUCTIONS FOR DRAFTING THE CONCEPT NOTE.................................................9

1.1. Summary of the action......................................................................................................9

1.2. Description of the action: (max 2 pages).........................................................................9

1.3. Relevance of the action (max 3 pages).............................................................................9

1.4. Lead applicant, (co-applicants and affiliated entities, if any)......................................11

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1 CONCEPT NOTE
You must follow the instructions at the end of this document on how to fill in the concept note.

1. Summary of the action

2. Fill in the table below:
<Overall objective(s) (i.e. Impact)>
Objectives of the action
<Specific objective(s) (i.e. Outcome(s)>
Target group(s)6
Final beneficiaries7
Estimated outputs
Main activities

3. Description of the action: cover all the 5 points in the instructions:

(max 2 pages)
<insert text here>

4.

6 Target groups are groups/entities who will directly benefit from the action at the action purpose level.
7 Final beneficiaries are those who will benefit from the action in the long term at the level of the society or sector
at large.
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5. Relevance of the action (max 3 pages)
6. Relevance to the objectives/sectors/themes/specific priorities of the call for
proposals
<insert text here>

7. Relevance to the particular needs and constraints of the target

country/countries, region(s) and/or relevant sectors (including synergy with
other EU initiatives and avoidance of duplication)
<insert text here>

8. Describe and define the target groups and final beneficiaries, their needs
and constraints, and state how the action will address these needs
<insert text here>

9. Particular added-value elements

<insert text here>

10.

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 11. Lead applicant, (co-applicants and affiliated entities, if any)
[Delete this section if you are applying via PROSPECT]

Name of the lead applicant

EuropeAid ID8
Nationality9/ Country and date of registration1011
Legal Entity File number12 (if available)
Legal status13

Lead applicant contact details for the purpose of this action

Postal address of the organisation:

Organisation email address:

Telephone: (fixed and mobile)

Country code + city code + number

Fax:
Country code + city code + number
Contact person for this action:

Postal address:

Contact person’s email:

Co-applicant(s) 14
Name of the co-applicant
EuropeAid ID15
Nationality/ Country and date of registration
Legal Entity File number (if available)
Legal status

8 To be inserted if the applicant is an organisation and is registered in PADOR (Potential Applicant Data On-Line
Registration). For more information and to register, please visit https://ec.europa.eu/europeaid/pador_en.
9 For individuals.
10 An organisation’s statutes must show that it was established under the national law of the country concerned and
that the head office is located in an eligible country. Any organisation established in a different country cannot be
considered an eligible local organisation. See the footnotes to the Guidelines for the call.
11 For organisations.
12 If the lead applicant has already signed a contract with the European Commission.
13 E.g. non-profit, governmental body, or international organisation.
14 Add as many rows as co-applicants
15 If this is a restricted call, this field is optional. For more information about the EuropeAid ID, please see footnote
6.
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Affiliated entity(ies)16
Name of the Affiliated entity
EuropeAid ID17
Nationality / country and date of registration
Legal status:
Specify to which entity you are affiliated (lead
applicant and/or the co-applicant).
Specify the kind of affiliation you have with that
entity.

12. Project details

[Delete this section if you are applying via PROSPECT]

Title of the action:

[Lot number you are applying to: ] e.g. Lot nº 2

Location(s) of the action: Specify country(ies), region(s), area(s) or

town(s) that will benefit from the action>
Total duration of the action (months): months
Requested EU contribution (amount) <EUR>
Requested EU contribution as a percentage of the %
total eligible costs of the action (indicative)18

2 DECLARATION BY THE LEAD APPLICANT

The lead applicant, represented by the undersigned, being the authorised signatory of the
lead applicant, and in the context of the present application, representing any co-
applicant(s) and affiliated entity(ies) in the proposed action, hereby declares that:
i. the lead applicant has the sources of financing and professional competence and qualifications
specified in Section 2 of the guidelines for applicants;
ii. the lead applicant undertakes to comply with the obligations foreseen in the affiliated entities'
statement of the grant application form and with the principles of good partnership practice;
iii. the lead applicant is directly responsible for the preparation, management and implementation of
the action with the co-applicant(s) and affiliated entity(ies), if any, and is not acting as an
intermediary;
iv. the lead applicant, the co-applicant(s) and the affiliated entity(ies)are not in any of the situations
excluding them from participating in contracts which are listed in Section 2.6.10.1. of the

16 Add as many rows as affiliated entities

17 If this is a restricted call, this field is optional. For more information about the EuropeAid ID, please see footnote
6.
18 If applicable, insert an additional % of the total accepted costs.
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 practical guide (available from the following Internet address:
http://ec.europa.eu/europeaid/prag/document.do the lead applicant and each co-applicant and
affiliated entity are in a position to deliver immediately, upon request, the supporting documents
stipulated under Section 2.4 of the guidelines for applicants;
v. the lead applicant and each co-applicant(s) and affiliated entity(ies) (if any) are eligible in
accordance with the criteria set out under Sections 2.1.1 and 2.1.2 of the guidelines for
applicants;
vi. if recommended to be awarded a grant, the lead applicant, the co-applicant(s) and the affiliated
entity(ies) accept the contractual conditions as laid down in the standard grant contract annexed
to the guidelines for applicants (Annex G) (or the Contribution Agreement where the lead
applicant is an organisation whose pillars have been positively assessed by the European
Commission);
We acknowledge that if we participate in spite of being in any of the situations listed in Section 2.6.10..1
of the practical guide or if the declarations or information provided prove to be false we may be subject
to rejection from this procedure and to administrative sanctions in the form of exclusion and financial
penalties up to 10 % of the total estimated value of the grant being awarded and that this information may
be published on the Commission website in accordance with the Financial Regulation in force. We are
aware that, for the purposes of safeguarding the EU’s financial interests, our personal data may be
transferred to internal audit services, to the early detection and exclusion system, to the European Court
of Auditors, to the Financial Irregularities Panel or to the European Anti-Fraud Office.

Signed on behalf of the lead applicant

Name
Signature

Position
Date

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 [Please delete the instructions below before submitting your concept note]
INSTRUCTIONS FOR DRAFTING THE CONCEPT NOTE
The lead applicant must ensure that the concept note:
 includes Page 1 of this document, filled in and submitted as a cover page of the concept note;
 includes the table of the summary of the action (without any limitation of size)
 includes the description of the action (not exceeding 2 pages) and the relevance of the action (not
exceeding 3 pages), the format for both documents being A4 size with 2 cm margins, Arial 10 font
characters and single line spacing;
 provides the information requested under the headings below, in the order requested, and in
proportion to its relative importance (see the relevant scores in the evaluation grid in the guidelines
for applicants);
 provides full information (as the evaluation will be based solely on the information provided);
 is drafted as clearly as possible to facilitate the evaluation process.
1. Summary of the action
13.Fill in the table

14. Description of the action: (max 2 pages)

i. Give the background to the preparation of the action, in particular on the sector/country/regional
context (including key challenges). Mention any specific analysis/study carried out to inform the
design (context analysis)
ii. Explain the objectives of the action given in the table in Section 1.1.
iii. Describe the key stakeholder groups, their attitudes towards the action and any consultations held.
iv. Briefly outline intervention logic underpinning the Action, indicating the expected outputs,
outcome(s) and impact as well as underlying the main risks and assumptions towards their
achievement.
v. Briefly outline the type of activities proposed, including a description of linkages/relationships
between activity clusters
vi. Explain how the Action will mainstream relevant cross-cutting issues such as promotion of human
rights19, gender equality20, democracy, good governance, support to youth, children’s rights and
indigenous peoples, environmental sustainability21 and combating HIV/AIDS (if there is a strong
prevalence in the target country/region).

14.1.1.1.1.1.1.1.1. Relevance of the action (max 3

pages)

19Including those of people with disabilities. For more information, see ‘Guidance note on disability and
development’ at https://ec.europa.eu/europeaid/disability-inclusive-development-cooperation-guidance-note-eu-
staff_en
20See Guidance on Gender equality at https://ec.europa.eu/europeaid/toolkit-mainstreaming-gender-equality-ec-
development-cooperation_en
21See Guidelines for environmental integration at https://ec.europa.eu/europeaid/sectors/economic-
growth/environment-and-green-economy/climate-change-and-environment_en
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15.Relevance to the objectives/sectors/themes/specific priorities of the call for
proposals
Please provide all the following information:
i. Describe the relevance of the action to the objective(s) and priority(ies) of the call for proposals.
ii. Describe the relevance of the action to any specific subthemes/sectors/areas and any other
specific requirements stated in the guidelines for applicants, e.g. local ownership etc.
iii. Describe which of the expected results referred to in the guidelines for applicants will be
addressed.
16.Relevance to the particular needs and constraints of the target
country/countries, region(s) and/or relevant sectors (including synergy with
other development initiatives and avoidance of duplication)
Please provide all the following information:
i. State clearly the specific pre-project situation in the target country/countries, region(s) and/or
sectors (include quantified data analysis where possible).
ii. Provide a detailed analysis of the problems to be addressed by the action and how they are
interrelated at all levels.
iii. Refer to any significant plans undertaken at national, regional and/or local level relevant to the
action and describe how the action will relate to such plans.
iv. Where the action is the continuation of a previous action, clearly indicate how it is intended to
build on the activities/results of this previous action; refer to the main conclusions and
recommendations of any evaluations carried out.
v. Where the action is part of a larger programme, clearly explain how it fits or is coordinated with
that programme or any other planned project. Specify the potential synergies with other
initiatives, in particular by the European Commission.
vi. Explain the complementarity with other initiatives supported by the EU and by other donors
(Member States & others)
NB: In exceptional cases where it is impossible to involve national organisations 22 from the target
country because of the particular situation in that country, the lead applicant must provide
explanations, which will be examined when applying criterion 1.1 of the evaluation grid to the
concept note.

17.Describe and define the target groups and final beneficiaries, their needs
and constraints, and state how the action will address these needs
Please provide all the following information:
i. Give a description of each of the target groups and final beneficiaries (quantified where possible),
including selection criteria.
ii. Identify the needs and constraints (including capacity constraints) of each of the target groups and
final beneficiaries.
iii. Demonstrate the relevance of the proposal to the needs and constraints of the target groups and
final beneficiaries.

22 See footnote 2.
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 iv. Explain any participatory process ensuring participation by the target groups and final
beneficiaries.

18.Particular added-value elements

Indicate any specific added-value elements of the action, e.g. the promotion or consolidation of public-
private partnerships, innovation and best practice.

19. Lead applicant, (co-applicants and affiliated entities, if any)

Any change in the addresses, phone numbers, fax numbers or e-mail, must be notified in writing to the
Contracting Authority. The Contracting Authority will not be held responsible in the event that it cannot
contact an applicant.

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 [Please delete the checklist below before submitting your concept note]

Checklist for self-guidance

EUROPEAID/170901/DH/ACT/MULTI
(To be filled in by the lead applicant only for self-guidance purposes)

Title of the Proposal:

Before sending your concept note

Yes No N/A
check that each of the criteria below have been met in full:
1. The correct grant application form has been used.
2. The Instructions for the concept note have been followed.
3. The proposal is typed and is written in an eligible language for this
call. (Where more than one language is allowed, the proposal is drafted
in the language most commonly used by the target population in the
country in which the action takes place.)
4. An electronic version of the concept note (CD-ROM) is enclosed
(Please write ‘Not applicable’ (N/A) if you are applying via
PROSPECT).
5. One original and the number of copy(ies) foreseen in section 2.2 of
the guidelines are included (Please write ‘Not applicable’ (N/A) if you
are applying via PROSPECT)
6. The Declaration by the applicant has been filled in and has been
signed.
7. The action will be implemented in an eligible country(ies).
8. The action will be implemented in the minimum number of countries
required (If a minimum number of countries is not mandatory: Please
write ‘Not applicable’ (N/A))
9. The duration of the action is equal to or higher than the minimum
allowed in section 2.1.4 of the guidelines.
10. The duration of the action is equal to or lower than the maximum
allowed in section 2.1.4 of the guidelines.
11. The requested EU contribution (amount) is equal to or higher than
the minimum allowed in section 1.3 of the guidelines.
12. The requested EU contribution (amount) is equal to or lower than
the maximum allowed in section 1.3 of the guidelines.

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