Tenderer

Chamber of Commerce (KVK) number

Do you not have a Chamber of Commerce number? Please fill in the field below.

Other EU registration number / reason no Chamber of Commerce number

Name organisation

Postal address

Postal code and location

Country

IBAN

BIC

Number of employees working at the organisation

Year of establishment of the organisation

Legal structure of the organisation

Name authorized signatory

Is the visiting address different from the postal address?

Yes

Visiting address

Postal code and location

Contact person at the tenderer

Name contact person

Titel(s)

Function

E-mail address

E-mail address confirmation

Telephone number

Please enter at least one telephone number.

Mobile telephone number

Please enter at least one mobile telephone number.

Intermediary

Have you authorised an intermediary to submit the tender on behalf of you?

Yes

Name organisation

Chamber of Commerce number

Postal address

Contact information intermediary

Name contact person

Titel(s)

Function

Role

Telephone number

Please enter at least one telephone number.

Mobile telephone number

Please enter at least one mobile telephone number.

E-mail address

E-mail address confirmation

Project

Name of the project

Acronym (abbreviation of initials)

Public summary of the project

This is a tender for

Phase 1

Phase 2

Phase 2a

Please enter the SBIR number of the tender request

This number starts with SB

Maximum tender amount as specified in the SBIR-call

Please verify if your offer amount does not exceed the maximum allowed.

Tender amount

Please verify if your tender amount does not exceed the maximum allowed.

Total project costs (your costs excluding VAT)

Total project costs (your costs including VAT)

I declare that I am quoting with a VAT rate of 0%

Did you also apply for and/or receive other subsidy(-ies)/contract(s) for this project?

Yes

Please enter the information of the other other subsidy(-ies)/contract(s)

Please fill in: name subsidy, grantor, status and amount of the subsidy.

Do you cooperate with other parties?

Yes

Is one or more of these parties a company?

Yes

Is one or more of these companies based abroad?

Yes

Is one or more of these companies a knowledge institution?

Yes

Is one or more of these knowledge institutions based abroad?

Yes

Attachments

You can download the mandatory attachments, complete them and then save them at your device. After that, you can upload the attachments in this form.

Please use the acronym as the title for all your digital files to enable correct and fast processing.
Example: acronym.projectplan.pdf

Attachment A project plan including management summary and budget

One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Attachment B Business plan

Mandatory for phase 2 offer

Attachment C Management summary as a separate (pdf) file

Mandatory for phase 1 offer

Attachment D Authorisation

Only required if an intermediary submits your offer

Any other attachments 1

Any other attachments 2

Any other attachments 3

Declaration

Please check the boxes below:

I am authorised and/or licensed to submit this SBIR tender.

I declare that this form and the attachments have been completed truthfully.

I have taken note of the SBIR Manual for companies (in Dutch).

I am familiar with and accept the conditions and procedures of this pre-commercial procurement as described in the SBIR documents.

My organisation complies with the conditions as stated in the SBIR documents.

If applicable: the partners named in the plan have seen a copy of the project plan and agree to it.