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FP7 - Grant Agreement - Annex VI - Combination of CP & CSA
Form C - Financial Statement (to be filled in by Third Party) Only applicable if special clause nr 10 is used Project Number Project Acronym Period from To 3rd party legal Name 3rd party Organisation Short Name Funding % for RTD activities (A) 261323 EGI-InSPIRE 01/05/2013 30/04/2014 RUSSIAN RESEARCH CENTRE KURCHATOV INSTITUTE RRCKI Working for beneficiary nr If flat rate for indirect costs, specify % 57 Is this an adjustment to a previous statement ? No Funding scheme Combination of CP & CSA

75.0

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1. Declaration of eligible costs/lump sum/flate-rate/scale of unit (in ) Type of Activity RTD (A) Personnel costs Subcontracting Other direct costs Indirect costs* Total costs Maximum EU contribution Requested EU contribution 0 0 0 0 0 0 Coordination (B) 0 0 0 0 0 0 Support (C) 0 0 0 0 0 0 Management (D) 0 0 0 0 0 0 Other (E) 10,274 0 0 2,054 12,328 12,328 Total (A+B+C+D+E) 10,274 0 0 2,054 12,328 12,328 4,069

* Indirect costs relating to : - "Coordination" and "Support"activities are reimbursed up to a maximum of 7% of the direct eligible costs relating to these activities excluding the direct eligible costs for subcontracting and the costs of resources made available by third parties which are not used on the premises of the beneficiary, - "RTD", "Management" and "other" activities are reimbursed in accordance with the various options foreseen in Article II.15.2 a), b) and c) of the grant agreement.

2. Declaration of receipts Did you receive any financial transfers or contributions in kind, free of charge from third parties or did the project generate any income which could be considered a receipt according to Art.II. 17 of the grant agreement ? If yes, please mention the amount (in ) 4. Certificate on the methodology Do you declare average personnel costs according to Art.II.14.1 ? Is there a certificate on the methodology provided by an independent auditor and accepted by the Commission according to Art.II.4.4 ? Cost of the certificate (in ), Name of the auditor if charged under this project . Certificate on the financial statements Is there a certificate on the financial statements provided by an independent auditor attached to this financial statement according to Art.II.4.4 ? Name of the auditor Cost of the certificate (in ) 6. Beneficiary's declaration on its honour We declare on our honour that: - the costs declared above are directly related to the resources used to attain the objectives of the project and fall within the definition of eligble costs specified in Articles II.14 and II.15 of the grant agreement, and, if relevant, Annex III and Article 7 (special clauses) of the grant agreement; - the receipts declared above are the only financial transfers or contributions in kind, free of charge, from third parties and the only income generated by the project which could be considered as receipts according to Art.II.17 of the grant agreement; - the interest declared above is the only interest yielded by the pre-financing which falls whithin the definition of Art.II.19 of the grant agreement; - there is full supporting documentation to justify the information hereby declared. It will be made available at the request of the Commission and in the event of an audit by the Commission and/or by the Court of Auditors and/or their authorised representatives. Beneficiary's Stamp Name of the Person(s) Authorised to sign this Finanancial Statement Vasily Velikhov Date & signature 10/10/2014 No No No No

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