ANNEX XXIII

| Fund concerned (1): | <type="S" input="S" > (2) Commission reference (CCI): | <type="S" input="S"> Name of programme: | <type="S" input="G"> Commission decision: | <type="S" input="G"> Date of Commission decision: | <type="D" input="G"> Payment application number: | <type="N" input="G"> Date of submission of the payment application: | <type="D" input="G"> National reference (optional): | <type="S" maxlength="250" input="M"> | According to Article 91, this payment application refers to the accounting year: From (3) | <type="D" input="G"> | until: | <type="D" input="G"> Expenditure broken down by priority and, where relevant, by category of region as entered into the accounts of the body carrying out the accounting function (Including programme contributions paid to financial instruments (Article 92 and advances paid in the context of State Aid (Article 91(5)) This table shall not include expenditure linked to specific objectives for which enabling conditions are not fulfilled, with the exception of operations that contribute to the fulfilment of enabling conditions Priority | Calculation basis (public or total) (4) | Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in accordance with point (a) of Article 91(3) and point (c) of Article 91(4) | Total amount of Union contribution pursuant to points (a) and (b) of Article 91(4) | Amount for technical assistance in accordance with point (b) of Article 91(3) | Total amount of public contribution made or to be made in accordance with point (c) of Article 91(3) (A) | (B) | (C) | (D) | (E) Priority 1 | | | | | Less developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | | | | | Less developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | | | | | Less developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> OR Expenditure broken down by specific objective as entered into the accounts of the managing authority Applicable for AMIF, ISF and BMVI This table shall not include expenditure linked to specific objectives for which enabling conditions are not fulfilled, with the exception of operations that contribute to the fulfilment of enabling conditions Specific objective | Calculation basis (public or total) | Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in accordance with point (a) of Article 91(3) and point (c) of Article 91(4) | Total amount of Union contribution pursuant to points (a) and (b) of Article 91(4) | Total amount of public contribution made or to be made in accordance with point (c) of Article 91(3) (A) | (B) | (C) | (D) Specific objective 1 | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(2) of ISF Regulation or Article 12(2) of BMVI Regulation or Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(3) of ISF Regulation or Article 12(3) of BMVI Regulation or Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of ISF Regulation or Article 12(4) of BMVI Regulation (excluding Special Transit Scheme) or Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of BMVI Regulation (Special Transit Scheme) | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of ISF Regulation or Article 12(6) of BMVI Regulation or Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of BMVI Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 2 | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(2) of ISF Regulation or Article 12(2) of BMVI Regulation or Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(3) of ISF Regulation or Article 12(3) of BMVI Regulation or Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of ISF Regulation or Article 12(4) of BMVI Regulation or Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of ISF Regulation or Article 12(6) of BMVI Regulation or Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 3 | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(2) of ISF Regulation or Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(3) of ISF Regulation or Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of ISF Regulation or Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of ISF Regulation or Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 4 (AMIF) | | | | Actions co-financed in line with Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 19 of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 20 of AMIF Regulation ('transfer in') | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 20 of AMIF Regulation ('transfer out') | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Technical assistance specific objective | | | | Technical assistance in accordance with Article 36(5) | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Technical assistance in accordance with Article 37 | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> The template is automatically adjusted on the basis of the CCI. For example, in the case of programmes not including categories of region (the Cohesion Fund, JTF, European territorial cooperation goal (Interreg), EMFAF if applicable) or programmes not modulating co-financing rates within a priority (specific objective), the table shall look as follows: This table shall not include expenditure linked to specific objectives for which enabling conditions are not fulfilled, with the exception of operations that contribute to the fulfilment of enabling conditions Priority | Calculation basis (public or total) (') | Total amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in accordance with point (a) of Article 91(3) and point (c) of Article 91(4) | Total amount of Union contribution pursuant to points (a) and (b) of Article 91(4) | Amount for technical assistance in accordance with point (b) of Article 91(3) | Total amount of public contribution made or to be made in accordance with point (c) of Article 91(3) | (A) | (B) | (C) | (D) | (E) Priority 1 | <type='S' input='C'> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | <type='S' input='C'> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | <type='S' input='C'> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> By validating this payment application the body carrying out the accounting function/managing authority requests the payment of the amounts as mentioned below. Representing the body carrying out the accounting function: Or Representing the managing authority responsible for the accounting function: | <type="S" input="G"> FUND | | Less developed regions | Transition regions | More developed regions | Outermost regions and Northern sparsely populated regions | (A) | (B) | (C) | (D) <type="S" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> The template is automatically adjusted on the basis of the CCI. For example, in the case of programmes not including categories of region (Cohesion Fund, JTF, European territorial cooperation goal (Interreg), EMFAF if applicable) or programmes not modulating co-financing rates within a priority (specific objective), the table shall look as follows: FUND | AMOUNT <type="S" input="G"> | <type="Cu" input="G"> Or Applicable for AMIF, ISF and BMVI Fund | | Amounts <type="S" input="G"> | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 12(2) of ISF Regulation or Article 12(2) of BMVI Regulation or Article 15(2) of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 12(3) of ISF Regulation or Article 12(3) of BMVI Regulation or Article 15(3) of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 12(4) of ISF Regulation or Article 12(4) of BMVI Regulation (excluding Special Transit Scheme) or Article 15(4) of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 12(4) of BMVI Regulation (Special Transit Scheme) | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 12(5) of ISF Regulation or Article 12(6) of BMVI Regulation or Article 15(5) of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 12(5) of BMVI Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 19 of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Actions co-financed in line with Article 20 of AMIF Regulation | <type="Cu" input="G"> <type="S" input="G"> | Technical assistance in accordance with Article 36(5) | <type="Cu" input="G"> <type="S" input="G"> | Technical assistance in accordance with Article 37 | <type="Cu" input="G"> The payment will be made on the following bank account: Body identified | <type="S" maxlength="150" input="G"> Bank | <type="S" maxlength="150" input="G"> BIC | <type="S" maxlength="11" input="G"> Bank account IBAN | <type="S" maxlength="34" input="G"> Holder of account (where not the same as the body identified) | <type="S" maxlength="150" input="G"> Priority | Amount included in the first payment application and paid to the financial instrument in accordance with Article 92 (maximum 30 % of the total amount of programme contributions committed to [the] financial instrument[s] under the relevant funding agreement) | Corresponding cleared amount as referred to in Article 92(3) (5) (A) | (B) | (C) | (D) Total amount of programme contributions paid to financial instruments | Total amount of corresponding public contribution | Total amount of programme contributions pursuant to Article 92(2)(b) | Total amount of corresponding public contribution Priority 1 | | | | Less developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Less developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Less developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> The template is automatically adjusted on the basis of the CCI. For example, in the case of programmes not including categories of region (Cohesion Fund, JTF, European territorial cooperation goal (Interreg), EMFAF if applicable) or programmes not modulating co-financing rates within a priority (specific objective), the table shall look as follows: Priority | Amount included in the first payment application and paid to the financial instrument in accordance with Article 92 (maximum 30 % of the total amount of programme contributions committed to [the] financial instrument[s] under the relevant funding agreement) | Corresponding cleared amount as referred to in Article 92(3) (6) (A) | (B) | (C) | (D) Total amount of programme contributions paid to financial instruments | Total amount of corresponding public contribution | Total amount of programme contributions pursuant to Article 92(2)(b) | Total amount of corresponding public contribution Priority 1 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Or Applicable for AMIF, ISF and BMVI Specific objective | Amount included in the first payment application and paid to the financial instrument in accordance with Article 92 (maximum 30 % of the total amount of programme contributions committed to [the] financial instrument[s] under the relevant funding agreement) | Corresponding cleared amount as referred to in Article 92(3) (7) (A) | (B) | (C) | (D) Total amount of programme contributions paid to financial instruments | Total amount of corresponding public contribution | Total amount of programme contributions pursuant to Article 92(2)(b) | Total amount of corresponding public contribution Specific objective 1 | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 2 | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 3 | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 4 (AMIF) | | | | Actions co-financed in line with Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Priority | Calculation basis (public or total) (8) | Amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in the meaning of Article 91(3), points (a) or (c) or Union contribution pursuant to Article 91(4) linked to non-fulfilled enabling conditions within the meaning of Article 15(5) or (6), with the exception of operations that contribute to the fulfilment of enabling conditions | Amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in the meaning of Article 91(3), points (a) or (c) or Union contribution pursuant to Article 91(4) linked to fulfilled enabling conditions within the meaning of Article 15(5) or (6), or contributing to the fulfilment of enabling conditions (9) Total | Public | Total | Public (A) | (B) | (C) | (D) | (E) Priority 1 | | | | | Less developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | | | | | Less developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | | | | | Less developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Specific objective | Calculation basis (public or total) | Amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in the meaning of Article 91(3), points (a) or (c) or Union contribution pursuant to Article 91(4) linked to non-fulfilled enabling conditions within the meaning of Article 15(5) or (6), with the exception of operations that contribute to the fulfilment of enabling conditions | Amount of eligible expenditure incurred by beneficiaries and paid in implementing operations in the meaning of Article 91(3), points (a) or (c) or Union contribution pursuant to Article 91(4) linked to fulfilled enabling conditions within the meaning of Article 15(5) or (6), or contributing to the fulfilment of enabling conditions (10) (A) | Total (B) | Public (C) | Total (D) | Public (E) Specific objective 1 | | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(2) of ISF Regulation or Article 12(2) of BMVI Regulation or Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(3) of ISF Regulation or Article 12(3) of BMVI Regulation or Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of ISF Regulation or Article 12(4) of BMVI Regulation (excluding Special Transit Scheme) or Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of BMVI Regulation (Special Transit Scheme) | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of ISF Regulation or Article 12(6) of BMVI Regulation or Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of BMVI Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 2 | | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(2) of ISF Regulation or Article 12(2) of BMVI Regulation or Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(3) of ISF Regulation or Article 12(3) of BMVI Regulation or Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of ISF Regulation or Article 12(4) of BMVI Regulation or Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of ISF Regulation or Article 12(6) of BMVI Regulation or Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 3 | | | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(2) of ISF Regulation or Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(3) of ISF Regulation or Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(4) of ISF Regulation or Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(5) of ISF Regulation or Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 4 (AMIF) | | | | | Actions co-financed in line with Article 15(1) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 15(2) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 15(3) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 15(4) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line Article 15(5) of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 19 of AMIF Regulation | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 20 of AMIF Regulation ('transfer in') | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 20 of AMIF Regulation ('transfer out') | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Technical assistance in accordance with Article 36(5) | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Technical assistance in accordance with Article 37 | <type="S" input="G"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="M"> Priority | Total amount paid as advances (11) | Amount which has been covered by expenditure paid by beneficiaries within three years following the year of the payment of the advance | Amount which has not been covered by expenditure paid by beneficiaries and for which the three year period has not yet elapsed (A) | (B) | (C) Priority 1 | | | Less developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | | | Less developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | | | Less developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Transition regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> More developed regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Totals | | | Less developed regions | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Transition regions | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> More developed regions | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Outermost regions and Northern sparsely populated regions | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Grand total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> The template is automatically adjusted on basis of the CCI. For example, in the case of programmes not including categories of region (Cohesion Fund, JTF, European territorial cooperation goal (Interreg), EMFAF) the table shall look as follows: Priority | Total amount paid as advances (12) | Amount which has been covered by expenditure paid by beneficiaries within 3 years of the payment of the advance | Amount which has not been covered by expenditure paid by beneficiaries and for which the 3 year period has not yet elapsed (A) | (B) | (C) Priority 1 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 2 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Priority 3 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G"> Or Applicable for AMIF, ISF and BMVI Funds Specific objective | Total amount paid as advances (13) | Amount which has been covered by expenditure paid by beneficiaries within three years of the payment of the advance | Amount which has not been covered by expenditure paid by beneficiaries and for which the three year period has not yet elapsed (A) | (B) | (C) Specific objective 1 | | | Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 2 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(1) of ISF Regulation or Article 12(1) of BMVI Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 3 | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Actions co-financed in line with Article 12(1) of ISF Regulation or Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Specific objective 4 (AMIF) | | | Actions co-financed in line with Article 15(1) of AMIF Regulation | <type="Cu" input="M"> | <type="Cu" input="M"> | <type="Cu" input="M"> Grand Total | <type="Cu" input="G"> | <type="Cu" input="G"> | <type="Cu" input="G">

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Source: EUR-Lex (Cellar) · retrieved 2026-10-28 · Text as adopted (Official Journal); later amendments are not incorporated in this text.