Call for proposals reference: EUBA-EFSA-2022-ENREL-02

Annex 5 - Declaration on honour on selection criteria
to be submitted only by the applicant/coordinator 

The undersigned [insert name of the signatory of this form], representing the following legal person: 

Full official name:
Official legal form: 
Statutory registration number: 
Full official address:
VAT registration number: 

(the legal person above is hereinafter referred to as ‘the person’)	

Declares that the person is fully eligible in accordance with the criteria set out in the specific call for proposals.

I certify that the person/consortium submitting the application has the financial and operational capacity to carry out the proposed action.

If awarded the grant, the person/consortium accepts the special and general conditions as laid down in the grant agreement.

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The person must immediately inform the EFSA of any changes in the situations as declared.
The person subject to this declaration may be subject to rejection from this procedure and to administrative sanctions (exclusion) if any of the declarations or information provided as a condition for participating in this procedure prove to be false.
Full name	Date	Signature

Your reply to the grant application will involve the recording and processing of personal data (such as your name, address and CV), which will be processed pursuant to Regulation (EC) No 45/2001 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. Unless indicated otherwise, your replies to the questions in this form and any personal data requested are required to assess your grant application in accordance with the specifications of the call for proposals and will be processed solely for that purpose by EFSA. Details concerning the processing of your personal data are available on the privacy statement at the page: http://www.efsa.europa.eu/en/procurement/docs/procurementprivacystatement.pdf 
Your personal data may be registered in the Early Detection and Exclusion System (EDES) if you are in one of the situations mentioned in Articles 136 to 140 of the Financial Regulation. For more information see the Privacy Statement on http://ec.europa.eu/budget/explained/management/protecting/protect_en.cfm#BDCE)