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Section A

I.DMC Information

Contact person name:*

Contact Person ID Card No.:*

Email Address:*

Company IBAN No.:*

Business Name:*

Business Address:*

Post Code:*

Telephone Number:*

Company Registration No.:*

Date:

Swift Code:*

II.Corporate Client Information

Company Name:*

Company Address:*

Rapresentative/s Name and Surname:*

Email Address:*

Contact Number:*

Section B

DMC MTA Licence:*

Signed declaration that demonstrates recognition that funds will be provided by the Ministry for Gozo (Note: Declaration template can be downloaded from Guidance Notes):*

Table with details of the participants/attendees (Note: Table template can be downloaded from Guidance Notes):*

Details of the venue including name and address of venue, the number of participants envisaged, estimate price and date/s of the MICE activity:*

Written correspondence showing reservation with the service provider including the number of participants envisaged, estimate price and date/s of the MICE activity:*

Detailed programme of activities and/or agenda including the Name of the Organizer of the MICE activity and the name of the MICE activity itself, the dates of the MICE activity, the catering and coffee breaks provisions and the themes presented:*

If applicable, reservation with the touring activity service provider including the number of participants envisaged, estimate price and date/s of the activity:

Section C

Declaration:*

Note: Download, print, fill in and upload the document named Declaration found at the top of this page

Section D

State Aid Declaration:*

Note: Download, print, fill in and upload the document named State Aid Declaration found at the top of this page

Support in Organizing and Hosting MICE Activities in Gozo Scheme