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| No. | Information required for each financial instrument |
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| I. Identification of the programme and priority or measure from which support from the ESI Funds is provided (Article 46(2)(a) of Regulation (EU) No 1303/2013) | |
| 1 | Priority axes or measures supporting the financial instrument, including fund of funds, under the ESI Fund programme |
| 1.1 | Reference (number and title) of each priority axis or measure supporting the financial instrument under the ESI Fund programme |
| 2 | Name of ESI Fund(s) supporting the financial instrument under the priority axis or measure |
| 3 | Thematic objective(s) referred to in the first paragraph of Article 9 of Regulation (EU) No 1303/2013 supported by the financial instrument |
| 4 | Other ESI Fund programmes providing contributions to the financial instrument |
| 4.1 | CCI number of each other ESI Fund programme providing contributions to the financial instrument |
| II. Description of the financial instrument and implementation arrangements (Article 46(2)(b) of Regulation (EU) No 1303/2013) | |
| 5 | Name of the financial instrument |
| 6 | Official address/place of business of the financial instrument (name of the country and city) |
| 7 | Implementation arrangements |
| 7.1 | Financial instrument set up at Union level, managed directly or indirectly by the Commission referred to in Article 38(1)(a) of Regulation (EU) No 1303/2013, supported from ESI Fund programme contributions |
| 7.1.1 | Name of the Union-level financial instrument |
| 7.2 | Financial instrument set up at national, regional, transnational or cross-border level, managed by or under the responsibility of the managing authority referred to in Article 38(1)(b), supported from ESI Fund programme contributions under points (a), (b) and (c) of Article 38(4) of Regulation (EU) No 1303/2013 |
| 8 | Type of the financial instrument |
| 8.1 | Tailor-made or financial instruments complying with standard terms and conditions |
| 8.2 | Financial instrument organised through fund of funds or without a fund of funds |
| 8.2.1 | Name of the fund of funds set up to implement financial instruments |
| 9 | Type of products provided by financial instrument: loans, micro-loans, guarantees, equity or quasi-equity investments, other financial product or other support combined within the financial instrument pursuant to Article 37(7) of Regulation (EU) No 1303/2013 |
| 9.1 | Description of the other financial product |
| 9.2 | Other support combined within the financial instrument: grant, interest rate subsidy, guarantee fee subsidy pursuant to Article 37(7) of Regulation (EU) No 1303/2013 |
| 10 | Legal status of the financial instrument, pursuant to Article 38(6) of Regulation (EU) No 1303/2013 (for financial instruments referred to in Article 38(1)(b) only): fiduciary account opened in the name of the implementing body and on behalf of the managing authority or separate block of finance within a financial institution |
| III. Identification of the body implementing the financial instrument as referred to in Articles 38(1)(a), 38(4)(a), (b) and (c) of Regulation (EU) No 1303/2013, and the financial intermediaries referred to in Article 38(5) of Regulation (EU) No 1303/2013 (Article 46(2)(c) of Regulation (EU) No 1303/2013) | |
| 11 | Body implementing the financial instrument |
| 11.1 | Type of implementing body pursuant to Article 38(4) of Regulation (EU) No 1303/2013: existing or newly created legal entity dedicated to implementing financial instruments; the European Investment Bank; the European Investment Fund; international financial institution in which a Member State is a shareholder; financial institution established in a Member State aiming at the achievement of public interest under the control of a public authority; a body governed by public or private law; managing authority undertaking implementation tasks directly (for loans or guarantees only) |
| 11.1.1 | Name of the body implementing the financial instrument |
| 11.1.2 | Official address/place of business (country and town name) of the body implementing the financial instrument |
| 12 | Procedure of selecting the body implementing the financial instrument: award of a public contract; other procedure |
| 12.1 | Description of the other procedure of selecting the body implementing the financial instrument |
| 13 | Date of signature of the funding agreement with the body implementing the financial instrument |
| IV. Total amount of programme contributions, by priority or measure, paid to the financial instrument and management costs incurred or management fees paid (Article 46(2)(d) and (e) of Regulation (EU) No 1303/2013) | |
| 14 | Total amount of programme contributions committed in the funding agreement (in EUR) |
| 14.1 | out of which ESI Funds contributions (in EUR) |
| 15 | Total amount of programme contributions paid to the financial instrument (in EUR) |
| 15.1 | out of which amounts of ESI Funds contributions (in EUR) |
| 15.1.1 | out of which ERDF (in EUR) |
| 15.1.2 | out of which Cohesion Fund (in EUR) |
| 15.1.3 | out of which ESF (in EUR) |
| 15.1.4 | out of which EAFRD (in EUR) |
| 15.1.5 | out of which EMFF (in EUR) |
| 15.2 | out of which total amount of national co-financing (in EUR) |
| 15.2.1 | out of which total amount of national public funding (in EUR) |
| 15.2.2 | out of which total amount of national private funding (in EUR) |
| 16 | Total amount of programme contributions paid to the financial instrument under Youth Employment Initiative (YEI) |
| 17 | Total amount of management costs and fees paid out of programme contributions (in EUR) |
| 17.1 | out of which base remuneration (in EUR) |
| 17.2 | out of which performance-based remuneration (in EUR) |
| 18 | Capitalised management costs or fees pursuant to Article 42(2) of Regulation (EU) No 1303/2013 (relevant only for final report) (in EUR) |
| 19 | Capitalised interest rate subsidies or guarantee fee subsidies pursuant to Article 42(1)(c) of Regulation (EU) No 1303/2013 (relevant for final report only) (in EUR) |
| 20 | Amount of programme contributions for follow-on investments in final recipients pursuant to Article 42(3) of Regulation (EU) No 1303/2013 (relevant for final report only) (in EUR) |
| 21 | Contributions of land and/or real estate in the financial instrument pursuant to Article 37(10) of Regulation (EU) No 1303/2013 (relevant for final report only) (in EUR) |
| V. Total amount of support paid to final recipients, or to the benefit of final recipients, or committed in guarantee contracts by the financial instrument for investments in final recipients, by ESI Funds programme and priority or measure (Article 46(2)(e) of Regulation (EU) No 1303/2013) | |
| 22 | Name of each financial product offered by the financial instrument |
| 23 | Date of signature of the funding agreement for the financial product |
| 24 | Total amount of programme contributions committed in loans, guarantee equity, quasi-equity or other financial product contracts with final recipients (in EUR) |
| 24.1 | out of which total amount of ESI Funds contributions (in EUR) |
| 25 | Total amount of programme contributions paid to final recipients through loans, micro-loans, equity or other products, or, in the case of guarantees, committed for loans paid to final recipients, by product (in EUR) |
| 25.1 | out of which total amount of ESI Funds contributions (in EUR) |
| 25.1.1 | out of which ERDF (in EUR) |
| 25.1.2 | out of which Cohesion Fund (in EUR) |
| 25.1.3 | out of which ESF (in EUR) |
| 25.1.4 | out of which EAFRD (in EUR) |
| 25.1.5 | out of which EMFF (in EUR) |
| 25.2 | out of which total amount of national public co-financing (in EUR) |
| 25.3 | out of which total amount of national private co-financing (in EUR) |
| 26 | Total value of loans actually paid to final recipients in relation to the guarantee contracts signed (EUR) |
| 27 | Number of loan/guarantee/equity or quasi-equity/other financial product contracts signed with final recipients, by product |
| 28 | Number of loan/guarantee/equity or quasi equity/other financial product investments made in final recipients, by product |
| 29 | Number of final recipients supported by the financial product |
| 29.1 | out of which large enterprises |
| 29.2 | out of which SMEs |
| 29.2.1 | out of which microenterprises |
| 29.3 | out of which individuals |
| 29.4 | out of which other type of final recipients supported |
| 29.4.1 | description of other type of final recipients supported |
| VI. The performance of the financial instrument, including progress in its set-up and in selection of bodies implementing the financial instrument (including the body implementing a fund of funds) (Article 46(2)(f) of Regulation (EU) No 1303/2013) | |
| 30 | Date of completion of the |
| 31 | Selection of bodies implementing financial instrument |
| 31.1 | number of selection procedures already launched |
| 31.2 | number of funding agreements already signed |
| 32 | Information whether the financial instrument was still operational at the end of the reporting year |
| 32.1 | If the financial instrument was not operational at the end of the reporting year, date of the winding-up |
| 33 | Total number of disbursed loans defaulted or total number of guarantees provided and called due to the loan default |
| 34 | Total amount of disbursed loans defaulted (in EUR) or total amount committed for guarantees provided and called due to loan default (in EUR) |
| VII. Interest and other gains generated by support from the ESI Funds to the financial instrument, programme resources paid back to financial instrument from investments as referred to in Articles 43 and 44, and the value of equity investments with respect to previous years (Article 46(2)(g) and (i) of Regulation (EU) No 1303/2013) | |
| 35 | Interest and other gains generated by payments from ESI Funds to the financial instrument (in EUR) |
| 36 | Amounts repaid to the financial instrument attributable to support from ESI Funds by the end of the reporting year (in EUR) |
| 36.1 | out of which capital repayments (in EUR) |
| 36.2 | out which gains, other earnings and yields (in EUR) |
| 37 | Amount of resources reused, which were paid back to the financial instrument and are attributable to ESI Funds |
| 37.1 | out of which amounts paid for preferential remuneration of private investors or public investors operating under the market economy principle who provide counterpart resources to the support from the ESI Funds to the financial instrument or who co-invest at the level of final recipient (in EUR) |
| 37.2 | out of which amounts paid for the reimbursement of management costs incurred and payment of management fees of the financial instrument (in EUR) |
| VIII. Progress in achieving the expected leverage effect of investments made by the financial instrument and value of investments and participations (Article 46(2)(h) of Regulation (EU) No 1303/2013) | |
| 38 | Total amount of other contributions, outside ESI Funds, raised by the financial instrument (EUR) |
| 38.1 | Total amount of other contributions, outside ESI Funds committed in the funding agreement with the body implementing the financial instrument (in EUR) |
| 38.2 | Total amount of other contributions, outside ESI Funds paid to the financial instrument (in EUR) |
| 38.2.1 | out of which public contributions (EUR) |
| 38.2.2 | out of which private contributions (EUR) |
| 38.3 | Total amount of other contributions, outside ESI Funds mobilised at the level of final recipients (in EUR) |
| 38.3.1 | out of which public contributions (EUR) |
| 38.3.2 | out of which private contributions (EUR) |
| 39 | Expected and achieved leverage effect, by reference to the funding agreement |
| 39.1 | Expected leverage effect for loan/guarantee/equity or quasi-equity investment/other financial product, by reference to the funding agreement, by product |
| 39.2 | Achieved leverage effect at the end of the reporting year for loan/guarantee/equity or quasi-equity investment/other financial product, by product |
| 40 | Value of investments and participations, with respect to previous years (in EUR) |
| IX. Contribution of the financial instrument to the achievement of the indicators of the priority or measure concerned (Article 46(2)(j) of Regulation (EU) No 1303/2013) | |
| 41 | Output indicator (code number and name) to which the financial instrument contributes |
| 41.1 | Target value of the output indicator |
| 41.2 | Value achieved by the financial instrument in relation to the target value of the output indicator |