Common Proposal For Vietnamese-Czech Joint R&d project



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* Total estimated costs including the proposed budget from MOST and TA CR support and private resources of all participants

** Will be generated by the TA CR information system

*** To be provided by MOST through the coordination of SATI; leave it blank.


  1. Affidavit

Organizations listed under Consortium Partners herein below (collectively referred to as the „consortium“) hereby declare and confirm as follows:

  • The consortium intends to collaborate on the above mentioned R&D project.

  • No organization in the consortium is in liquidation and insolvency or impending bankruptcy is not being dealt with in insolvency proceedings.

  • No organization in the consortium is in financial difficulty.

Consortium Partners

1a) Principal Applicant / Lead Organization

(on the Czech side)

Name of institution/enterprise:


Address:
Phone:
Fax:
Website:

Contact Person
Name:

Position:


Division/Department:
Phone (direct):

Email:



1b) Principal Applicant / Lead Organization

(on the Vietnamese side)

Name of institution/enterprise:


Address:
Phone:
Fax:
Website:

Contact Person
Name:

Position:


Division/Department:
Phone (direct):

Email:


2a) Participating Organization

(on the Czech side)

Name of institution/enterprise:


Address:
Phone:
Fax:
Website:

Contact Person


Name:
Division/Department:
Phone (direct):
Email:

2b) Participating Organization

(on the Vietnamese side)

Name of institution/enterprise:


Address:
Phone:
Fax:
Website:

Contact Person


Name:
Division/Department:
Phone (direct):
Email:

3a) (add more as necessary)

3b) …


  1. Finance


1a) Total Project Budget of the Principal Applicant (on the Czech side) – USD

Name of institution/enterprise:



Indicator

2017*

2018

2019

Total

Costs













Support from TA ČR













Private sources













* Please leave blank.

If the government contribution does not cover all project costs, how will you finance the rest of project costs (own profit of the company, bank loan, …)? (please specify amounts and sources of financing of the project)







1b) Total Project Budget of the Principal Applicant (on the Vietnamese side) – USD

Name of institution/enterprise:



Indicator

2017*

2018

2019

Total

Costs













Proposed budget from MOST













Private sources













* Please leave blank.

If the government contribution does not cover all project costs, how will you finance the rest of project costs (own profit of the company, bank loan, …)? (please specify amounts and sources of financing of the project)







2a) Total Project Budget of the Participating Organization (on the Czech side) – USD

Name of institution/enterprise:



Indicator

2017*

2018

2019

Total

Costs













Support from TA ČR













Private sources













* Please leave blank.

If the support does not cover all project costs, how will you finance the rest of project costs (own profit of the company, bank loan, …)? (please specify amounts and sources of financing of the project)








2b) Total Project Budget of the Participating Organization (on the Vietnamese side)- USD

Name of institution/enterprise:



Indicator

2017*

2018

2019

Total

Costs













Proposed budget from MOST













Private sources













* Please leave blank.

If the support does not cover all project costs, how will you finance the rest of project costs (own profit of the company, bank loan, …)? (please specify amounts and sources of financing of the project)









3a) a 3b) add more as necessary

  1. Resumé of the project

  1. Project Description

[Provide a descriptive overview of the proposed project: project aims/objectives, description of research activity, and expected outcomes. Also specify expected outcomes achieved by each participant.]

  1. Roles of each Lead Organization and Participating Organization

[Provide in a tabular form what activities each organization intend to perform. Suggested column headings: Task no, Task Name, Description, Deliverables]

  1. Implementation Path

[Describe the implementation plan for the result of the R&D project such as commercialization, industry member utilization, etc.]

  1. Basis for cooperation

[Why do you want to cooperate on the above mentioned project?]

  1. Intellectual Property Rights

[How will the IPR related to the project be dealth with? Who will own the IPR to the project results? Describe how the rights to practice the project deliverables (both tangible and intangible) will be used.]



  1. Statutory representative/member of a statutory body/representative with authorization to sign on behalf of the organization (according to the commercial or other register).



(signature) (Date)

Principal Applicant on the Czech side




(signature) (Date)

Principal Applicant on the Vietnamese side

(Print Name)
(Position)
(Name of Organization)





(Print Name)
(Position)
(Name of Organization)










(signature) (Date)

Paticipation Organization

on the Czech side




(signature) (Date)

Paticipation Organization

on the Vietnamese side

(Print Name)
(Position)
(Name of Organization)





(Print Name)
(Position)
(Name of Organization)










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