AnnexNb-PADORDerogPack-Partner by gianni conte

EuropeAid/128764/C/ACT/Multi – ANNEX NB

ANNEX N B

PADOR DEROGATION PACK

PARTNER

THIS ANNEX MUST BE FILLED IN BY PARTNERS WHO REQUEST DEROGATION FROM THE OBLIGATION TO REGISTER IN PADOR. ALL OTHER PARTNERS MUST ENCODE THIS INFORMATION IN PADOR ( http://ec.europa.eu/europeaid/work/onlineservices/pador/index_en.htm)

Justification of the request for derogation from the obligation to register in PADOR: Annexed supporting documents substantiating the request for derogation (if any):

1. IDENTITY Name of the organisation:

Nationality: Ongoing contract /Legal Entity File number (if 1

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available)1: National registration number: Date of registration: VAT number: Postal address:

Telephone number: Country code + city code + number Fax number: Country code + city code + number Contact person: Contact person's email: Email address of the Organisation: Website of the organisation:

PROFILE

Legal status ProfitMaking NGO Value based2 1

□ Yes □ No □ Yes □ No □ Political □ Religious

If the applicant has already signed a contract with the European Commission / has been informed of the relevant Legal Entity File number. If neither of these apply, indicate N/A 2

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□ Humanistic □ Neutral Is your organisation linked with □ Yes, parent entity: (please specify its EuropeAid ID:…………………………) another entity? □ Yes, controlled entity(ies) □ Yes, family organisation / network entity3 □ No, independent

2.1. Category4

Category

Public

Private

□ Public Administration □ Decentralised representatives of Sovereign States □ International Organisation □ Judicial Institution □ Local Authority □ Implementation Agency □ University/Education □ Research Institute □ Think Tank □ Foundation □ Association □ Media □ Network/Federation □ Professional and/or Industrial Organisation □ Trade Union □ Cultural Organisation □ Commercial Organisation □ Other Non State Actor

Implementation Agency University/Education Research Institute Think Tank Foundation Association Media Network/Federation Professional and/or Industrial Organisation Trade Union Cultural Organisation Commercial Organisation Other Non State Actor

Please choose only one set of values.

E.g. confederation/federation/alliance.

Please specify 1) the Sector to which your organisation belongs, as defined in its statutes (or equivalent document): Public (established and/or funded by a public body) OR Private (established and/or funded by a private entity); 2) in the appropriate column, the Category to which your organisation belongs (ONE CHOICE ONLY). 3

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□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ 5

11 111 11110 11120 11130 11182 112 11220 11230 11240 113 11320 11330 114 11420 11430 12 121 12110 12181 12182 12191 122 12220 12230 12240 12250 12261 12281 13 130 13010 13020 13030 13040 13081 14

Sector(s)5

Education Education, level unspecified Education Policy & Admin. Management Education Facilities And Training Teacher Training Educational Research Basic education Primary Education Basic life skills for youth and adults Early childhood education Secondary education Secondary education Vocational Training Postsecondary education Higher Education Advanced Tech. & Managerial Training Health Health, general Health Policy & Admin. Management Medical education/training Medical Research Medical Services Basic health Basic Health Care Basic Health Infrastructure Basic Nutrition Infectious Disease Control Health Education Health Personnel Development Population programmes Population polices/programs and reproductive health Population Policy And Admin. Mgmt Reproductive Health Care Family planning Std Control Including HIV/Aids Personnel development for population & reproductive health Water Supply and Sanitation

Please tick the box for each sector your organisation has been active in. The sectors starting with a reference come from the DAC list set up by the OECD. 4

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□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

140 14010 14015 14020 14030 14040 14050 14081 15 151 15110 15120 15130 15140 15150 15161 15162 15163 15164 152 15210 15220 15230 15240 15250 15261 16 16010 16020 16030 16040 16050 16061 16062 16063 16064 21 210 21010 21020 21030 21040 21050

Water supply and sanitation Water Resources Policy/Admin. Mgmt Water Resources Protection Water supply & sanitation Large systems Basic drinking water supply & basic sanitation River Development Waste Management/Disposal Education & training in water supply and sanitation Government and Civil Society Government and civil society, general Economic and development policy/planning Public sector financial management Legal and judicial development Government administration Strengthening civil society Elections Human Rights Free Flow Of Information Women's equality organisations and institutions Conflict prevention an resolution, peace and security Security system management and reform Civilian peacebuilding, conflict prevention and resolution Postconflict peacebuilding (UN) Reintegration and SALW control Land mine clearance Child soldiers (prevention and demobilisation) Other Social Infrastructure and Service Social/welfare services Employment policy and admin. mgmt. Housing policy and admin. management Lowcost housing Multisector aid for basic social services Culture and recreation Statistical capacity building Narcotics control Social mitigation of HIV/AIDS Transport and Storage Transport and storage Transport Policy & Admin. Management Road Transport Rail Transport Water Transport Air Transport 5

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□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

21061 21081 22 220 22010 22020 22030 22040 23 230 23010 23020 23030 23040 23050 23061 23062 23063 23064 23065 23066 23067 23068 23069 23070 23081 23082 24 240 24010 24020 24030 24040 24081 25 250 25010 25020 31 311 31110 31120 31130

Storage Education & Training In Transport & Storage Communications Communications Communications Policy & Admin. Mgmt Telecommunications Radio/Television/Print Media Information and communication technology (ICT) Energy Energy generation and supply Energy Policy And Admin. Management Power Generation/NonRenewable Sources Power Generation/Renewable Sources Electrical Transmission/Distribution Gas distribution OilFired Power Plants GasFired Power Plants CoalFired Power Plants Nuclear Power Plants Hydroelectric Power Plants Geothermal energy Solar energy Wind power Ocean power Biomass Energy education/training Energy research Banking and Financial Services Banking and financial services Financial Policy & Admin. Management Monetary institutions Formal Sector Financial Institutions Informal/SemiFormal Financial intermediaries Education/trng in banking & fin. services Business and Other Services Business and other services Business support services and institutions Privatisation Agriculture, Forestry and Fishing Agriculture Agricultural Policy And Admin. Mgmt Agricultural development Agricultural Land Resources 6

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□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

31140 31150 31161 31162 31163 31164 31165 31166 31181 31182 31191 31192 31193 31194 31195 312 31210 31220 31261 31281 31282 31291 313 31310 31320 31381 31382 31391 32 321 32110 32120 32130 32140 32161 32162 32163 32164 32165 32166 32167 32168 32169

Agricultural Water Resources Agricultural inputs Food Crop Production Industrial Crops/Export Crops Livestock Agrarian reform Agricultural alternative development Agricultural extension Agricultural Education/Training Agricultural Research Agricultural services Plant and postharvest protection and pest control Agricultural financial services Agricultural cooperatives Livestock/Veterinary Services Forestry Forestry Policy & Admin. Management Forestry development Fuel wood/charcoal Forestry education/training Forestry research Forestry services Fishing Fishing Policy And Admin. Management Fishery development Fishery education/training Fishery research Fishery services Industry, Mining and Construction Industry Industrial Policy And Admin. Mgmt Industrial development Small and mediumsized enterprises (SME) development Cottage industries and handicraft AgroIndustries Forest industries Textiles leather & substitutes Chemicals Fertilizer plants Cement/lime/plaster Energy manufacturing Pharmaceutical production Basic metal industries 7

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□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

32170 32171 32172 32182 322 32210 32220 32261 32262 32263 32264 32265 32266 32267 32268 323 32310 33 331 33110 33120 33130 33140 33181 332 33210 41 410 41010 41020 41030 41040 41050 41081 41082 43 430 43010 43030 43040 43050 43081 43082

Nonferrous metal industries Engineering Transport equipment industry Technological research and development Mineral resources and mining Mineral/Mining Policy & Admin. Mgmt Mineral Prospection And Exploration Coal Oil and gas Ferrous metals Nonferrous metals Precious metals/materials Industrial minerals Fertilizer minerals Offshore minerals Construction Construction Policy And Admin. Mgmt Trade and Tourism Trade policy and regulation Trade Policy And Admin. Management Trade facilitation Regional trade agreements (RTAs) Multilateral trade negotiation Trade education & training Tourism Tourism Policy And Admin. Management General Environment Protection General environmental protection Environmental Policy And Admin. Mgmt Biosphere protection Biodiversity Site Preservation Flood Prevention/Control Environmental education/training Environmental research Other multisector Other multisector Multisector Aid Urban Development And Management Rural Development Nonagricultural alternative development Multisector education/training Research/scientific institutions 8

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□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

51 510 51010 52 520 52010 53 530 53030 53040 60 600 60010 60020 60030 60040 60061 60062 60063 72 720 72010 72040 72050 73 730 73010 74 740 74010 91 910 91010 92 920 92010 92020 92030 93 930 93010 99 998

General budget support General budget support General budget support Development food aid/food security Development food aid/food security assistance Food Aid / Food Security Programmes Other commodity assistance Other commodity assistance Import support (capital goods) Import support (commodities) Action relating to debt Action relating to debt Action relating to debt Debt forgiveness Relief of multilateral debt Rescheduling and refinancing Debt for development swap Other debt swap Debt buyback Emergency and distress relief Emergency and distress relief Material relief assistance and services Emergency food aid Relief coordination; protection and support services Reconstruction relief and rehabilitation Reconstruction relief and rehabilitation Reconstruction relief and rehabilitation Disaster prevention and preparedness Disaster prevention and preparedness Disaster prevention and preparedness Administrative costs of donors Administrative costs of donors Administrative Costs Support to NGO Support to NGO Support to national NGOs Support to international NGOs Support to local and regional NGOs Refugees Refugees (in donor countries) Refugees (in donor countries) Unallocated/unspecified Unallocated/unspecified 9

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□ □

99810 99820

Sectors Not Specified Promotion of Development Awareness

2.3.

Target group(s)

□ All □ Child soldiers □ Children (less than 18 years old) □ Community Based Organisation(s) □ Consumers □ Disabled □ Drug consumers □ Educational organisations (school, universities) □ Elderly people □ Illness affected people (Malaria, Tuberculosis, HIV/AIDS) □ Indigenous peoples □ Local authorities □ Migrants □ Non Governmental Organisations □ Prisoners □ Professional category □ Refugees and displaced □ Research organisations/Researchers □ SME/SMI □ Students □ Urban slum dwellers □ Victims of conflicts/catastrophes □ Women □ Young people □ Other (please specify): ……………………………..

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3. CAPACITY TO MANAGE AND IMPLEMENT ACTIONS 3.1.

Sector

Experience by Sector (for each sector selected in 2.2)

Year(s) of Experience □ Less than 1 □ 1 to 3 years □ 4 to 7 years □ 7 years +

Number of Projects □ 1 to 5 □ 6 to 10 □ 11 to 20 □ 21 to 50 □ 51 to 200 □ 201 to 500 □ 500 +

□ Less than 1 □ 1 to 3 years □ 4 to 7 years □ 7 years +

□ 1 to 5 □ 6 to 10 □ 11 to 20 □ 21 to 50 □ 51 to 200 □ 201 to 500 □ 500 +

□ Less than 1 □ 1 to 3 years □ 4 to 7 years □ 7 years +

□ 1 to 5 □ 6 to 10 □ 11 to 20 □ 21 to 50 □ 51 to 200 □ 201 to 500 □ 500 +

Estimated Amount (in thousand Euros) □ ≤10 □ >10 ≤50 □ >50 ≤200 □ >200 ≤500 □ >500 ≤1m □ >1m ≤3m □ >3m ≤10m □ >10m □ ≤10 □ >10 ≤50 □ >50 ≤200 □ >200 ≤500 □ >500 ≤1m □ >1m ≤3m □ >3m ≤10m □ >10m □ ≤10 □ >10 ≤50 □ >50 ≤200 □ >200 ≤500 □ >500 ≤1m □ >1m ≤3m □ >3m ≤10m □ >10m

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3.2.

Experience by Geographical area (country or region)

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By Geographical area (country or Year(s) of Experience region) □ Less than 1 □ 1 to 3 years □ 4 to 7 years □ 7 years +

□ Less than 1 □ 1 to 3 years □ 4 to 7 years □ 7 years +

Number of Projects □ 1 to 5 □ 6 to 10 □ 11 to 20 □ 21 to 50 □ 51 to 200 □ 201 to 500 □ 500 + □ 1 to 5 □ 6 to 10 □ 11 to 20 □ 21 to 50 □ 51 to 200 □ 201 to 500 □ 500 + □ 1 to 5 □ 6 to 10 □ 11 to 20 □ 21 to 50 □ 51 to 200 □ 201 to 500 □ 500 +

Indicative list of regions Central Asia Region Eastern Asia Region South Asia Region South East Asia Region Caribbean Region EU Europe Europe apart from EU Eastern Europe Region Central American Region South America Region North America Countries Gulf States Mediterranean Region Overseas countries and territories Pacific Region Central Africa Region East Africa Region Southern Africa Region West Africa Region Indian Ocean Region 13

EuropeAid/128764/C/ACT/Multi – ANNEX NB Crossreference of experience by Sector and by Geographical area:

Sector(s) (as selected in 2.2)

Geographical area(s) (country or region, as identified previously)

3.3.

Resources

The data registered on this section can be further explained under the Strategy & Methodology section. If some or all these indicators are not relevant to your organisation, please type ''0''.

3.3.1. Financial data (amounts in thousands EUR). Year

Turnover or equivalent

Net earnings or equivalent

Total balance sheet or budget

Shareholders’ equity or equivalent

Medium and longterm debt

Shortterm debt (< 1 year)

N N1 N2

3.3.2. Financing Source(s) (please tick the source(s) of the revenues of your organisation and specify the additional information requested) Year

Source

Percentage (total for a given year must be equal to 100%)

Number of feepaying members (only for source = Member's fees) 14

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N N N N N

Year

N – 1 N – 1 N – 1 N – 1 N – 1 N – 1 N – 1 N – 1 N – 1 N – 1 N – 2 N – 2 N – 2 N – 2 N – 2 N – 2 N – 2 N – 2 N – 2 N – 2

Source

Percentage (total for a given year must be equal to 100%)

□ EU Commission □ Member States Public Bodies □ Third Countries Public Bodies □ United Nations □ Other International Organisation(s) □ Private Sector □ Member's fees □ Donations from individuals □ Other (please specify): ………… Total 100% □ EU Commission □ Member States Public Bodies □ Third Countries Public Bodies □ United Nations □ Other International Organisation(s) □ Private Sector □ Member's fees □ Donations from individuals □ Other (please specify): ………… Total 100%

N/A N/A N/A N/A N/A N/A N/A N/A N/A

Number of feepaying members (only for source = Member's fees) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

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3.3.3. Number of staff (fulltime equivalent) (please tick one option for each type of staff): Type of staff

Paid

Unpaid

HQ Staff: recruited and based in Headquarters (located in Developed Country)

□ < 10

□ > 10 and < 50

□ > 50 and < 100

□ > 100

□ N/A

□ < 10

□ > 10 and < 50

□ > 50 and < 100

□ > 100

□ N/A

□ < 10

□ > 10 and < 50

□ > 50 and < 100

□ > 100

□ N/A

Expat Staff: recruited in Headquarters (located in Developed Country) and based in Developing Country

Local staff: recruited and based in Developing Country

Percentage Female/Male total paid staff Female

Male

4. LIST OF THE MANAGEMENT BOARD/COMMITTEE OF YOUR ORGANISATION (NOT OBLIGATORY) Title

Name

Profession

Function

Country of Nationality

On the board since

Mr 16

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Title

Name

Profession

Function

Country of Nationality

On the board since

Ms Add rows if necessary.

5. STRATEGY AND METHODOLOGY (NOT OBLIGATORY) To be developed in 20 000 characters (you may cut and paste unformatted text): Strategies/methodologies/philosophies and approaches of your organization How do you chose a country/region, a project, a partner Conditions to create a strong partnership, ownership, « participatory approach », …