Name of the applicant:

Place of operation:

Name of the project leader and its phone number, fax number and email address:

Type of organisation:

Partners and their contribution:

Financial data of the operation for the last 3 years (sales, EBIT, public dues, permanent assets, operational assets, internal capital, long-term loan, short-term loan, subsidies received)

Organisational data (number of employees, number of contracted persons, description of the project team):

DETAILS OF THE PROJECT

Main goals of the project:

Short description of the project including the list of the main activities by year:

Duration of the project:

How does the project meet the objectives of EU biodiversity strategy, national nature conservation strategy (protection status of the area, potential NATURA 2000 site?, affected species listed in the Annexes of Bern and Bonn Convention)?

Main expected achievements in relation to biodiversity (indicators: e.g. affected protected land, endangered species and ecosystems):

Main expected social effects:

FINANCIAL AND ECONOMIC INFORMATION ON THE PROJECT

Costs of the project (by activity, by types of costs, by year):

Expected benefits of the project:

Profitability of the project (NPV, IRR):

Risks related to the project:

Sources of funding (contribution of the applicant, government subsidies, contribution of the bank, other) indicating the form of funding as well (refundable, non refundable)

Requested form of funding:

Requested amount of funding (division per year)

REQUESTED APPENDICES

1. CV of the project leader

2. References (description of biodiversity related projects with duration and co-operation partners for each project)