LEONARDO DA VINCI NATIONAL AGENCY / EUROPEAN COMMISSION

LEONARDO DA VINCI PROGRAMME 

Contract Amendment Request Form
Pilot projects (including Thematic actions), Language competencies, Transnational networks, Reference material

Agreement number: 	Contracting period:	
Year:	Country:	Project duration:                  (months)	
Title:	
Contractor:	
Contractor legal representative:	
Previous amendments	Yes  No 	

DECLARATION OF CONFORMITY

I, the undersigned, hereby declare that the attached information is accurate and in accordance with the facts. This information has been approved by the authorities representing the partners involved in the project detailed within this request.
...........................................................................................................………………………………………………………

(Original signature of the person legally authorised to act on	
behalf of the contracting organisation and who signed the original agreement) 
Name of contractor's legal representative: ………………………………………………..……………………
Position within the contracting organisation:…………….................…………………………..……………… 
Place & Date:	………………………………………………………………………......……………………… .

Form to be returned to the following address: 
Procedure B - (Appropriate National Agency)

Procedure C - Technical Assistance Office
Rue de Trèves, 59-61
1040 Brussels - Belgium

AMENDMENT SUMMARY

Amendments to the agreement are subject to written requests, dated and signed by the contractor's legal representative. These amendments are also subject to formal endorsement by the National Agency or the Commission (Procedure C projects). 

Please note that an amendment only takes effect following signature by the National Agency or the Commission (this will be in the form of an official, signed amendment to the contract)

Following the on-line completion of the appropriate section(s) of this form, please print, sign, date and send by ordinary mail, together with an accompanying letter and all appropriate annexes, to the National Agency or the Commission (Procedure C projects).

For further information, please also refer to the Administrative and Financial Handbook (section III.1)

The present request for amendment, to the initial agreement (including previous amendments), concerns one or more of the following items (please, tick the box(es), as appropriate):

 	A - Change of the contracting organisation 
 	B - Partner(s) withdrawal
 	C - New / Replacement partner(s) joining the project1
 	D - Changes to the work programme2
 	E - Change of bank account
 	F - Changes to the project duration
 	G - Changes to the reporting schedule3
 	H - Changes to the budget
 	I - Other

A.	Change of the contracting organisation	

New Contractor
Name of the new contracting organisation in national language (full and abbreviated if applicable)	(full)	
	(abbreviated)	
Name of the organisation in EN, FR or DE		
Head Office
Street		
Number		
Post code		
Town/city		
Country		
Contact Person
Name	Mr□   Ms□		
Position		
Street		
Number		
Post code		
Town/city		
Country		
Telephone	++	/	
Fax	++	/	
E-mail		

Authorised signatory
Name	Mr□   Ms□		
Position		

Organisation type code4	Region code4	Sector code4 (max 3)	Size code4	

Reasons for withdrawal of existing contracting organisation (max 1/2 page)	

	

Tasks taken over by the new contracting organisation and/or (re)distribution of related tasks amongst the partners (max 1/2 page)	

	

List of annexes to be sent with this amendment request (mail delivery):
a)	Copy of the report from the withdrawing contractor to the new contractor detailing both activities undertaken and related expenditure (plus all supporting documents)
b)	Original letter from the new contracting organisation approving this report and undertaking to act as the new contractor and to pursue the remaining project activities
c)	Copy of the draft take-over protocol
d)	Original letters of acceptance by all partners
e)	Copy of the legal statutes of the organisation and copies of the financial accounts relating to the last three years (required for financial assessment of the organisation)

NB: Please note that replacement of the contracting organisation will not only imply changes of bank account (section E) but would normally also imply changes to the initial budget. Revised financial tables will therefore need to be considered (section H)

B.	Partner(s) withdrawal	

Please provide detail on the partner(s) that have withdrawn and explain why

Name of the partner organisation that has withdrawn	
1		
2		
3		
…		

Reasons for withdrawal (max 1/2 page)	
1		
2		
3		
…		

Where no new partner is joining, please comment upon the (re)distribution of the tasks amongst the existing partners.(max 1/2 page)	

	

Where new / replacement partner(s) are joining the project, please also complete section C.

List of annexes to be sent with this amendment request (mail delivery):
a) Original letter, dated and signed by the legal representative, of the withdrawing partner
b) Report on the status of the work carried out by the withdrawing partner, the rights acquired relating to individual products and results, the procedure for termination (including an end date), the funds already received by the partner, a breakdown of existing expenditure and the amount to be paid back (if any)
c) A revised Table D.1 (list of partners and budget by partner)

NB: Please note that partner(s) withdrawal would normally imply changes to the initial budget. Revised financial tables will therefore need to be considered (refer to section H)

C.	New / Replacement partner(s) joining the project	

Please provide detail on the partner(s) that have joined and explain why

C.1 - Information sheet on the new partner
Name of the organisation/institution in national language 		
Country Code 		
Organisation type code 		
Region code 		
Sector code 		
Size code 		
Contact Person
Name	Mr□   Ms□		
Street		
Number		
Post code		
Town/city		
Telephone	++	/	
Fax	++	/	
E-mail		

C.2 - Reasons for joining

If this partner replaces a partner that has withdrawn, please indicate the name of the withdrawing partner: 

Will this partner act as the Co-ordinator of the project? Yes  No 

Will this partner act as the Scientific Co-ordinator of the project? Yes  No 

Reasons for joining (max 1/2 page)	

	

Tasks taken over by the new partner and/or (re)distribution of the tasks amongst all partners (max 1/2 page)	

	

Please add extra sheets if necessary.

List of annexes to be sent with this amendment request (mail delivery):
a) Original of the commitment letter, including the partners own financial contribution, dated and signed by the legal representative of the organisation wishing to join the project (refer to the Administrative and Financial Handbook, section III.1)
b) Where appropriate (i.e. already effected), copy of the contract concluded between the contractor and the new partner
c) A revised Table D.1 (list of partners and budget by partner)

NB: Please note that new / replacement partner(s) joining the project would normally imply changes to the initial budget. Revised financial tables will therefore need to be considered (refer to section H)

D.	Changes to the work programme	

Please list work packages and clearly and briefly describe the proposed changes to the work programme 

Work packages5	Organisations involved 	
N°	Title of Work package	Start date (d/m/y)	End date (d/m/y)		
WP 1					
WP 2					
WP 3					
…					

Work packages	Proposed changes to the work programme, including any justification6 (1/2 page maximum)	
WP 1		
WP 2		
WP 3		
…		

E.	Change of bank account 	

BANKING SHEET OF THE CONTRACTING ORGANISATION

Financial Identification Sheet to be downloaded, completed and signed by the relevant parties and further submitted with this Contract Amendment Request Form.

Available to download from: http://europa.eu.int/comm/education/programmes/leonardo/new/leonardo2_en.html  

F. 	Changes to the project duration	

Project Commencement date (dd/mm/yyyy):		
Previous termination date (dd/mm/yyyy):		
Change requested (months)7		
New termination date (dd/mm/yyyy):		

G.	Changes to the reporting schedule	

Interim Report 	Final Report 

Previous deadline (dd/mm/yyyy):		
Extension requested (days and/or months):		
New deadline (dd/mm/yyyy):		

Interim Report 	Final Report 

Previous deadline (dd/mm/yyyy):		
Extension requested (days and/or months):		
New deadline (dd/mm/yyyy):		

 H.	Changes to the budget 	

NB: Please note that neither the total amount of the Leonardo da Vinci grant, nor the lump sums agreed for Staff or Overheads Costs shall be increased. 

Table G.1 - Breakdown of the total proposed budget

	Proposed budget (Euro) 	Proposed LdV Grant (Euro)
	
 A. Staff costs 			
 B. Operating costs* 			
 1. Travel 			
 2. ICT 			
 3. Production 			
 4. Overheads 			
 5. Others 			
 Sub-total B 			
 C. Subcontracting costs*			
 1.  			
 2.  			
 3… 			
 … 			
 …			
 Sub-total C 			
TOTAL			

Table G.2. Breakdown of the proposed budget / Leonardo grant by partner (Euro)

	Total proposed
budget	P1	P2	P3	P4	P…	
A. Staff costs							
B. Operating costs*	
1. Travel							
2. ICT							
3. Production							
4. Overheads							
5. Others							
Sub-total B 							
C. Sub-contracting costs*	
1.							
2.							
3. …							
Sub-total C							
TOTAL							
Leonardo da Vinci Grant							

Please justify any proposed changes to the agreed project budget (maximum 1 page)

	

List of annexes to be sent with this amendment request (mail delivery):
a) Agreement by all funded project partners, relating to the proposed budget changes
b) Original letters of acceptance by all partners which have direct changes to their budget (global and / or Leonardo da Vinci contribution)

I.	Other	

Please detail any other proposed changes to your project (maximum 1 page)

	

 

Receipt Acknowledgement
Contract Amendment Request Form	

This page will be returned to you when we have received your Contract Amendment Request Form. Please therefore complete the information below.
Title of project:

Name of contracting organisation		
Name of legal representative		
Street Number			Street		
Country code - Post code - Town/City		
Fax number		
			
Date you sent in your request	…….... / ..…….. / ..……..	

Reserved for National Agency / Commission:

Documents received:
Contract Amendment Request Form	Original + copy + electronic copy	
Annexes		

Missing data, to be submitted as soon as possible (not later than two weeks):

	

We acknowledge receipt of your Contract Amendment Request Form:
	
Country	Year	Project type	Project number	
		PP / TH / LA / NT / RF		

Please use this number in all communication with the National Agency / European Commission.	

Yours sincerely

Date: _________	Signature: ____________________________________________
Name: __________________________________________________________________
Position: __________________________________