TEIP-KIS Proposal: Exclusion form - participants

Form D: Standard Form concerning the Exclusion criteria

Put on your own letterhead

The undersigned:

Complete Official Name of the candidate company or organisation :

Official legal status:

Legal address:

Registration number:

VAT number:

Name of the signatory of this form (representative legally authorised to represent the candidate vis-à-vis third parties and acting on behalf of the aforementioned company or organisation):

declares on his honour that the company or organisation that he represents:

• is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors, has not suspended business activities, is not the subject of proceedings concerning those matters, and is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

• has not been convicted of an offence concerning professional conduct by a judgment which has the force of res judicata;

• has not been guilty of grave professional misconduct proven by any means which the contracting authorities can justify;

• has fulfilled its obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the country in which it is established, or with those of the country of the contracting authority or those of the country where the contract is to be carried out;

• has not been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the Communities' financial interests;

• are currently subject to an administrative penalty referred to in Article 96 (1) of the Financial Regulations.

The Commission shall accept as satisfactory evidence that the candidate:

• is not in one of the situations described in a), b) or e) above, production of a recent extract from the judicial record or, failing that, a recent equivalent document issued by a judicial or administrative authority in the country of origin or provenance showing that those requirements are satisfied;

• is not in the situation described in d) above, a recent certificate issued by the competent authority of the Member State concerned. Where no such document or certificate is issued by the country concerned, it may be replaced by a declaration under oath or, failing that, a solemn statement made by the candidate before a judicial or administrative authority, a notary or a qualified professional body in his country of origin or provenance.

Depending on the national legislation of the country in which the candidate is established, the documents referred to above shall relate to legal persons and/or natural persons including, where considered necessary by the Commission, company directors or any person with powers of representation, decision-making or control in relation to the candidate.

By returning this form, duly signed, the candidate undertakes to send to the Commission, within seven calendar days following the receipt of the Commission's request, these documents and any document the Commission considers necessary to perform its checks.

In addition, the undersigned declares on his honour:

g) that on the date of submission of the proposal, the company or organisation he represents and the staff proposed for this action are not subject to a conflict of interests in the context of this call for proposals; he undertakes to inform the Commission without delay of any change to this situation after the date of submission of the proposal.

h) that the information provided to the Commission within the context of this call for proposals is accurate, sincere and complete.

By signing this form, the undersigned acknowledges that he has been acquainted with the administrative and financial penalties specified in articles 114.2 and 114.3 of the financial regulation (OJEU L 248/1 of 16.9.2002) and in article 175 of the detailed rules for the implementation of the financial regulation (OJEU L 357/1 of 31.12.2002), which may be applied if one of the situations described in points a) to h) above arises.

Full name Date

Signature