ANNEX V

Payment request for Grant Contract

European Union external actions

18 December 2019

For the attention of

Ms. Eva Maria Troya Blanco- Head of Delegation of the
European Union to Lebanon
P.O. Box 11-4008 Riad El Solh, Beirut 1107 2150,
LEBANON
Finance and Contracts
FPI Regional Team Middle East

Reference number of the Grant Contract: ICSP/2017/389-693

Title of the Grant Contract: “Assistance in Accounting for Iraq’s Missing and Disappeared Persons”

Name and address of the Coordinator: International Commission on Missing Persons (ICMP)

Koninginnegracht 12, 2514AA The Hague, Netherlands

Payment request number: 2

Period covered by the payment request: Further pre-financing payment

Dear Sir/Madam,

I hereby request a further pre-financing payment under the Contract mentioned above.

The amount requested is EUR 1,002,200.00 according to the option indicated in Article 4(1) of the
Special Conditions of the Contract.

Please find attached the following supporting documents:

 narrative and financial interim report

 a forecast budget for the subsequent reporting period.

15 January 2016 Page 1 of 2

EU FPI Iraq II Payment request.doc
The payment should be made to the following bank account:

Beneficiary : ICMP
Bank: UBS Bank, P.O.BOX 2600

CH-1204 Geneva, Switzerland

Bank Account number :0240-364.202.70 Q

Currency : EUR

IBAN: CH86 0024 0240 3642 0270 Q

SWIFT: UBSWCHZH80A

Declaration on honour

I hereby certify that the information contained in this payment request is full, reliable and true, and is
substantiated by adequate supporting documents that can be checked.

I hereby certify that the costs declared have been incurred in accordance with this Contract and that
they can be considered as eligible in accordance with the Contract.

Yours faithfully,

Simon Short

Direct or of Corporate Services

15 January 2016 Page 2 of 2

EU FPI Iraq II Payment request.doc