ANNEX II

Template for an application for a financial contribution from the reserve, including elements related to the accounts

1. Member State 2. Date of application 3. Date of first expenditure Date incurred Date paid 4. Date of last expenditure Date incurred Date paid 5. Amount of pre-financing received (in EUR) 6. Body (1) or bodies responsible for the management of the financial contribution from the Reserve Responsible person and function Contact details 7. Independent audit body Responsible person and function Contact details 8. Body or bodies to which tasks have been delegated, where applicable 9. Short description of the areas and sectors affected by the withdrawal of the United Kingdom from the Union and the response measures put in place 10. When carried out, a short description of the multi-level dialogue 11. Total expenditure incurred and paid before deductions 12. Amounts deducted by the Member State and the reasons for deduction 13. In particular, out of the amounts deducted under point 12., the amounts corrected as a result of audits of the measures financed 14. Total expenditure submitted for the financial contribution from the Reserve (EUR) (14 = 11 – 12) 15. In national currency (where applicable) For Member States whose currency is not the euro: please convert all amounts into euro at the monthly accounting exchange rates established by the Commission published at: https://ec.europa.eu/info/funding-tenders/how-eu-funding-works/information-contractors-and-beneficiaries/exchange-rate-inforeuro_en 16. Monthly accounting exchange rates established by the Commission 17. Territorial distribution of the expenditure at NUTS level 2 regions, where relevant 18. Breakdown of expenditure submitted for the financial contribution from the Reserve, including the amount of resources spent in accordance with Article 4(4) (please provide a list of the individual actions financed under each measure and the related expenditure for each action) Each expenditure item should be entered only once EUR National currency (if applicable) Output indicators (please provide a number) 18.1. Measures to support private and public businesses, in particular SMEs, the self-employed, local communities and organisations adversely affected by the withdrawal of the United Kingdom from the Union Enterprises (supported) Enterprises supported (advised) Population benefiting 18.2. Measures to support the economic sectors most adversely affected by the withdrawal of the United Kingdom from the Union Enterprises (supported) Enterprises supported (advised) 18.3. Measures to support businesses, regional and local communities and organisations, including small-scale coastal fisheries, dependent on fishing activities in United Kingdom waters, in waters of special status territories or in waters covered by fisheries agreements with coastal states where fishing opportunities for Union fleets have been reduced as a result of the United Kingdom’s withdrawal from the Union Enterprises (supported) Enterprises supported (advised) Population benefiting 18.4. Measures to support job creation and protection, including green jobs, short-time work schemes, re-skilling and training in sectors most adversely affected by the withdrawal of the United Kingdom from the Union Participants 18.5. Measures to ensure the functioning of border, and security controls, including additional personnel and their training, and infrastructure Additional Personnel (in FTE) Physical infrastructure adapted (m2) 18.6. Measures to ensure the functioning of customs and collection of indirect taxation, including additional personnel and their training, and infrastructure Additional Personnel (in FTE) Physical infrastructure adapted (m2) 18.7. Measures to ensure the functioning of sanitary and phytosanitary and fisheries controls, including additional personnel and their training, and infrastructure Additional Personnel (in FTE) Physical infrastructure adapted (m2) 18.8. Measures to facilitate regimes for certification and authorisation of products, to assist in meeting establishment requirements, to facilitate labelling and marking, for example for safety, health, environmental standards, as well as to assist in mutual recognition Enterprises (supported) Enterprises supported (advised) 18.9. Measures for communication, information and awareness-raising of citizens and businesses about changes to their rights and obligations stemming from the withdrawal of the United Kingdom from the Union Enterprises supported (advised) Population covered 18.10. Measures aimed at the reintegration of Union citizens as well as persons having the right to reside on the territory of the Union who left the United Kingdom, as a result of the withdrawal of the United Kingdom from the Union Persons 18.11. Other (please specify) 19. Any complementary Union funding received or requested for expenditure not included in this application Short description/amount (e.g. use of cohesion policy funding/REACT-EU/JTF/RRF/other – please specify) 20. Please indicate the legal entity and the full bank account number and holder in case of a further payment ☐ Account used previously to receive EU payments ☐ New account

Template for the management declaration to accompany the application for a financial contribution from the Reserve

I/We, the undersigned [name(s), first name(s), title(s) or function(s)], Head of the body responsible for the management of the financial contribution from the Reserve, based on the implementation of the Reserve during the reference period, based on my/our own judgement and on all information available to me/us at the date of the application submitted to the Commission, including the results from verifications carried out and from audits in relation to the expenditure included in the application submitted to the Commission in respect of the reference period, and taking into account my/our obligations under Regulation (EU) 2021/1755 of the European Parliament and of the Council (2), hereby declare that:

(a) the information in the application is properly presented, complete and accurate in accordance with Article 63 of the Financial Regulation,

(b) the expenditure entered in the application complies with applicable law and was used for its intended purpose,

(c) the control systems put in place ensure the legality and regularity of the underlying transactions.

I/We confirm that irregularities identified in the final audit and control reports in relation to the reference period have been appropriately treated in the application. Furthermore, I/we confirm the reliability of data relating to the implementation of the Reserve. I/we also confirm that effective and proportionate anti-fraud measures are in place and that those measures take account of the risks identified in that respect.

Finally, I/we confirm that I/we am/are not aware of any undisclosed matter related to the implementation of the Reserve which could be damaging to the reputation of the Reserve.

Template for the audit opinion to accompany the application for a financial contribution from the Reserve

To the European Commission, Directorate-General for Regional and Urban Policy

1. INTRODUCTION

I, the undersigned, representing [the name of the independent audit body], have audited

(i) the elements related to the accounts in the application for the reference period;

(ii) the legality and regularity of the expenditure for which reimbursement has been requested from the Commission; and

(iii) the functioning of the management and control system for the Reserve, and verified the management declaration,

in order to issue an audit opinion.

2. RESPONSIBILITIES OF THE BODY (3) RESPONSIBLE FOR THE MANAGEMENT OF THE FINANCIAL CONTRIBUTION FROM THE RESERVE

[name of the body] is identified as the body responsible to ensure proper functioning of the management and control system for the Reserve with regard to the functions and tasks provided for in Article 14.

In addition, [the name of body] is responsible to ensure and declare the completeness, accuracy and veracity of the application.

Moreover, it is the responsibility of the body responsible for the management of the financial contribution from the Reserve to confirm that the expenditure entered in the application is legal and regular and complies with applicable law.

3. RESPONSIBILITIES OF THE INDEPENDENT AUDIT BODY

As established by Article 63 of the Financial Regulation, my responsibility is to express an independent opinion on the completeness, veracity and accuracy of the elements related to the accounts in the application, on the legality and regularity of the expenditure for which reimbursement has been requested from the Commission, and on the proper functioning of the management and control system for the Reserve put in place.

My responsibility is also to include in the opinion a statement as to whether the audit work puts in doubt the assertions made in the management declaration.

The audits in respect of the Reserve were carried out in accordance with internationally accepted audit standards. Those standards require that the independent audit body complies with ethical requirements, plans and performs the audit work in order to obtain reasonable assurance for the purpose of the audit opinion.

An audit involves performing procedures to obtain sufficient and appropriate evidence to support the opinion set out below. The procedures performed depend on the auditor’s professional judgement, including assessing the risk of material non-compliance, whether due to fraud or error. The audit procedures performed are those I believe are appropriate in the circumstances and are compliant with the requirements of the Financial Regulation.

I believe that the audit evidence gathered is sufficient and appropriate to provide the basis for my opinion [[in case there is any scope limitation:], except where mentioned in Point 4 ‘Scope limitation’].

The summary of the findings from the audits in respect of the Reserve are reported in the attached report in accordance with point (b) of Article 63(5) of the Financial Regulation.

4. SCOPE LIMITATION

Either

There were no limitations on the audit scope.

Or

The audit scope was limited by the following factors:

(a) …;

(b) …;

(c) ….

[Indicate any limitation on the audit scope, for example any lack of supporting documentation, cases under legal proceedings, and estimate under ‘Qualified opinion’ below, the amounts of expenditure and contribution from the Reserve affected and the impact of the scope limitation on the audit opinion. Further explanations in this regard shall be provided in the report, as appropriate.]

5. OPINION

Either (Unqualified opinion)

In my opinion, and based on the audit work performed:

(i) the elements related to the accounts in the application give a true and fair view;

(ii) expenditure included in the application is legal and regular; and

(iii) the management and control system for the Reserve functions properly.

The audit work carried out does not put in doubt the assertions made in the management declaration.

Or (Qualified opinion)

In my opinion, and based on the audit work performed:

(1) The elements related to the accounts in the application — the elements related to the accounts in the application give a true and fair view [where the qualification applies to the application, the following text is added:] except in the following material aspects: ….

(2) Legality and regularity of the expenditure included in the application — the expenditure included in the application is legal and regular [where the qualification applies to the application, the following text is added:] except for the following aspects: …. The impact of the qualification is limited [or significant] and corresponds to … (amount in EUR of the total amount of expenditure).

(3) The management and control system for the Reserve in place as at the date of this audit opinion — the management and control system for the Reserve put in place functions properly [where the qualification applies to the management and control system for the Reserve, the following text is added:] except for the following aspects: …. The impact of the qualification is limited [or significant] and corresponds to …. (amount in EUR of the total amount of expenditure). The audit work carried out does not put/puts [delete as appropriate] in doubt the assertions made in the management declaration.

[Where the audit work carried out puts in doubt the assertions made in the management declaration, the independent audit body shall disclose in this paragraph the aspects leading to this conclusion.]

Or (Adverse opinion)

In my opinion, and based on the audit work performed:

(i) the elements related to the accounts in the application give/do not give [delete as appropriate] a true and fair view; and/or

(ii) the expenditure in the application for which reimbursement has been requested from the Commission is/is not [delete as appropriate] legal and regular; and/or

(iii) the management and control system for the Reserve put in place functions/does not function [delete as appropriate] properly.

This adverse opinion is based on the following aspects:

— in relation to material matters related to the application: [please specify] and/or [delete as appropriate]

— in relation to material matters related to the legality and regularity of the expenditure in the application for which reimbursement has been requested from the Commission: [please specify] and/or [delete as appropriate]

— in relation to material matters related to the functioning of the management and control system for the Reserve: [please specify].

The audit work carried out puts in doubt the assertions made in the management declaration as regards the following aspects:

[The independent audit body may also include emphasis of matter, not affecting its opinion, as established by internationally accepted auditing standards. A disclaimer of opinion can be given in exceptional cases.]

Date:

Signature:

(1) Where applicable in accordance with Article 14(1), point (a), the information shall be provided for all bodies responsible for the management of the financial contribution from the Reserve.

(2) Regulation (EU) 2021/1755 of the European Parliament and of the Council of 6 October 2021 establishing the Brexit Adjustment Reserve (OJ L 357, 8.10.2021, p. 1).

(3) Where applicable in accordance with Article 14(1), point (a), the information shall be provided for all bodies responsible for the management of the financial contribution from the Reserve.