Facility Improvement Fund - Acquittal Form

Project Details

Financial Year*

Name of Section 355 Committee*

Contact Name*

Contact Number*

Email Address*

Project Name*

Please provide feedback on the success of your project / how did you measure the success of your project?*

Please upload photos of the project implementation / completion*

Second photo attachment (if required)

Summary of Project Finance

Income

A - Cash Contribution Paid by Committee ($0.00)*

B - In-kind Contribution ($0.00)*

C - Other funding obtained (eg. grants/donations) ($0.00)*

D - Amount provided by Council ($0.00)*

E - Total Income Allocated for the Project ($0.00)

Expenditure

A - Please attach proof of expenditure equal to or in excess of Income Item A above.*

A - What is the total of the invoices attached? ($0.00)*

B - Please provide details of the in-kind contribution made to the project. The total estimated in-kind must be equal to or in excess of Income Item B above.

B - What is the total estimated in-kind contribution? ($)*

C - Please attach proof of expenditure equal to or in excess of Income Item C above

C - What is the total of the invoices attached? ($0.00)

D - Please attach proof of expenditure equal to or in excess of Income Item D above

D - What is the total of the invoices attached? ($0.00)*

E - Total expenditure allocated to the Project ($) This is the total of A+B+C+D equals E

I confirm that the information provided in this acquittal form is correct to the best of my knowledge and all expenditure aligns with the approved funding under the Facility Improvement Fund guidelines as at the time of the successful application.*

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