Final financial report and payment applications as referred to in point (g) of Article 19(1)One table per survey in poultry/wild birds (a)Member State: Date:Reporting period from: to:Measures eligible for co-financing (b)Methods of laboratory analysisNumber tests performed per methodCostsSerological pre-screening (c)Haemagglutination-inhibition-test (HI) for H5/H7Virus isolation testPCR testOther measures to be coveredSpecify activitiesSamplingOthersTotalHerewith I certify that the data given above are correct and that no other Community contribution was requested for these measures.(a) Strike through as appropriate.(b) Data to be given in national currency, VAT excluded (Place, Date).(c) Please indicate test used (Signature).