Non Exclusion Declaration

Certification and declaration on honour

I certify 

•	that our organisation is committed to participate in the following project (Project Acronym and Title).
•	that the information relating to our organisation set out in the A2 forms is accurate and correct, 
•	that the estimated costs meet the criteria for eligible costs for ICT PSP projects, as established by the ICT PSP model grant agreement and our normal cost accounting principles, and that they reflect the estimated costs expected to be incurred in carrying out the work described in Part B of the proposal (Description of work).

As required by Article 114 of the Financial Regulation and Article 174 of the Implementing Rules to the Financial Regulation I declare on my honour that our organisation is NOT in any of the following situations of exclusion as specified in Articles 93 and 94 of the Financial Regulation:

•	it is bankrupt or being wound up, is having its affairs administered by the courts, has entered into an arrangement with creditors, has suspended business activities, is the subject of proceedings concerning those matters, or is in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
•	it has been convicted of an offence concerning its professional conduct by a judgement which has the force of res judicata;
•	it has been guilty of grave professional misconduct proven by any means which the contracting authority can justify;
•	it has not fulfilled 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 performed;
•	it has 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;
•	it is currently subject to an administrative penalty imposed the European Community, consisting in the exclusion from contracts or grants financed by the Community budget, and/or the payment of financial penalties;
•	is subject to a conflict of interest or;
•	is guilty of misrepresentation in supplying information required by the European Community as a condition of participation in a procurement procedure or grant award procedure or failed to supply this information.

[Signature]
[Name First name(s)]
[Full Legal Name of organisation]
[Date]

Stamp of organisation and Signature of the legal representative of the organisation.