Details of each partner

Surname:
First Name:
Job title:
Department:
Museum or Organisation:

Legal status:
(please attach a copy of the legal statutes, if applicable)
Address:

.
.

Country:
Telephone number:
Fax number:
E-Mail:

If not a museum, specify the field of work:

.
.

If a museum, please fill out:
Museum typology:
Who runs it?
Area it serves:
Audience it serves:
Is it currently accessible to the public?
Annual budget in ECU:
Percentage of items displayed:
Exhibition surface area:
Number of total staff:
Number of qualified staff:
Number of visitors per year:

State the museum collections (main periods, disciplines, geographical areas, etc.):

.
.
.
.

Specify museums with which you already work regularly:

.
.
.
.
.
.

Budget related to the partner's participation in the project

EXPENDITURE		INCOME
Detailed items	National currency	Sources of income	National currency
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
.	.	.	.
TOTAL		TOTAL

Bank details of the partner

Name of the bank account holder:
Bank account number:
Name of the bank:
Full address of the bank:

.
.

Date:
Signature of the partner: