Report on new irregularities

1. Report from (Beneficiary State)	

	
2. Type of reporting (tic one of the alternatives)	
Immediate reporting of irregularities according to 3.2 of the Irregularities Guideline		
Regular report on new irregularities according to 3.3 of the Irregularities Guideline		
	
3. Reporting Period and reference number	
3.1 Report for period from and including 	(month/year)		
	To and including (month/year)		
3.2 Reference number of this report		
	
4. Irregularities / no irregularities to report 	
4.1 If no suspected or actual irregularities, tick this box (parts 5 and 6 of this table does 	not need completing)		
4.2 If suspected or actual irregularities, tick this box (parts 5 and 6 of this table must be 	completed)		
	
5. Project information	
5.1 Project name
	
5.2 FMO Number
	
5.3 Total amount of support for the project in €
	
5.4 Division of amount in €	

NO FM	
EEA FM	
Other	
	
6. Irregularity description	
6.1 Provision or provisions which have been infringed 

	
6.2 Description of the irregularity (also whether the irregularity is actual or suspected), including 	practices employed when committing the irregularity

	
6.3 Nature and amount of the expenditure wrongfully incurred by the irregularity, or in cases where 	no payments have been made, the amounts which would have been wrongly paid had the 	irregularity not been discovered 

	
6.4 Period during which, or the moment at which, the irregularity was committed

	
6.5 Manner in which the irregularity was discovered, including the date and source of the first 	information leading to suspicion that an irregularity was in evidence

	
6.6 National authorities or bodies which drew up the official report (also internal reports) on the 	irregularity and the date on which the reports were drawn up

	
6.7 Financial consequences of the irregularity including suspension of payments and the possibilities 	for recovery

	
6.8	Other countries involved (where appropriate)

6.9	Identity of the natural and/or legal persons involved (except in cases where such information is 	of no relevance in combating the irregularity on account of the character of the irregularity 	concerned)

	
6.10	Any procedures, including criminal investigation initiated because of the irregularity and the 	stage reached in this procedure, including the stage of recovery

	
6.11 Measures taken or envisaged to prevent the recurrence of the case of irregularity already 	detected

	
6.12 Other information

	

Report completed in

__________________________________________________________________
(place) 							(date)

By

__________________________________________________________________
 (name, position)