Form „Self-Declaration to the Sanctions Regulation“
(Annex 7 to the Letter of Tender)
[To be completed by the tenderer / each member of a group of tenderers, as well as by any third party on whose suitability the tenderer / group of tenderers relies, and by subcontractors]
| Name of the tenderer / | Please enter here |
| of the member of the group of tenderers/ | Please enter here |
| of capacity-providing undertaking | Please enter here |
| address | Please enter here |
1. I/We declare that I/we do not belong to any of the persons, organisations or entities listed in Article 5k(1) of Regulation (EU) No 833/2014 (as amended by Council Regulation (EU) 2022/576 of 8 April 2022) (see Annex), namely:
(a) Russian nationals, natural persons residing in Russia, or legal persons, organisations or entities established in Russia,
(b) legal persons, organisations or entities whose proprietary rights are owned more than 50 % directly or indirectly by a person, organisation or entity referred to under point (a), or
(c) natural or legal persons, organisations or entities acting on behalf of or at the direction of a person, organisation or entity referred to under point (a) or (b).
2. I/We undertake that, in the event of contract award, no persons, organisations or entities within the meaning of point 1 above will participate in the performance of the contract as subcontractors, capacity-providing undertakings or suppliers (where they account for more than 10 % of the contract value)
| Place | Date | Name of authorised signatory[1] | Company |
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Annex
Article 5k of Regulation (EU) No 833/2014
(1) It shall be prohibited to award or to continue the performance of any public contracts or concessions falling within the scope of the public procurement Directives, as well as within the scope of Article 10(1), (3), (6)(a) to (e), (8), (9) and (10), and Articles 11, 12, 13 and 14 of Directive 2014/23/EU, Article 7(a) to (d), Article 8, Article 10(b) to (f) and (h) to (j) of Directive 2014/24/EU, Article 18, Article 21(b) to (e) and (g) to (i), Articles 29 and 30 of Directive 2014/25/EU, and Article 13(a) to (d), (f) to (h) and (j) of Directive 2009/81/EC, to or with:
(a) Russian nationals, natural persons residing in Russia, or legal persons, organisations or entities established in Russia,
(b) legal persons, organisations or entities whose proprietary rights are owned more than 50 % directly or indirectly by an entity referred to in point (a) of this paragraph, or
(c) natural or legal persons, organisations or entities acting on behalf of or at the direction of an entity referred to in point (a) or (b) of this paragraph,
including, where they account for more than 10 % of the contract value, subcontractors, suppliers or entities whose capacities are being relied on within the meaning of the public procurement Directives.
(2) By way of derogation from paragraph 1, the competent authorities may authorise the award or the continuation of the performance of contracts which are aimed at:
(a) the operation, maintenance, decommissioning, spent nuclear fuel and waste management of civil nuclear capacities, and the continuation of design, construction and commissioning required to complete civil nuclear facilities, the supply of precursor materials for the production of medical radio-isotopes and similar medical applications, or critical technology for environmental radioactive monitoring, as well as civil nuclear cooperation, in particular in the field of research and development,
(b) intergovernmental cooperation in space programmes,
(c) the provision of strictly necessary goods or services which can only be provided by, or are in sufficient quantity or volume only available from, the persons referred to in paragraph 1,
(d) the operation of diplomatic and consular representations of the Union and Member States in Russia, including delegations, embassies and missions, or of international organisations in Russia enjoying immunities in accordance with international law, or
(e) the purchase, import or transport into the Union of natural gas and oil, including refined petroleum products, as well as titanium, aluminium, copper, nickel, palladium and iron ore from or through Russia, unless prohibited under Article 3m or 3n.
(3) The Member State concerned shall inform the other Member States and the Commission of any authorisation granted under this Article within two weeks of granting such authorisation.
(4) The prohibitions set out in paragraph 1 shall not apply to the performance, until 10 October 2022, of contracts concluded before 9 April 2022.
- Text form pursuant to Section 126b BGB is sufficient. ↑