DARWIN INITIATIVE GRANT CLAIM FORM

Actual Expenditure – Main, Post and Darwin Plus

This form covers both Final Claims and Q4 Actual claims for 2017-18

Please send one signed claim to Darwin Finance, Signatures should match those on the current signatory panel.

FOR DEFRA USE ONLY

Darwin Reference No: / Received date
Grantee Organisation: / Accepted date
Reason for any significant difference above
Project Title: / Submitted early
Payment withheld against reporting
Clarification required
Awaiting audit/final review
  1. Claim period
/ Other
Expenditure from: / (Month and year) / PO number:
Expenditure to: / (Month and year) / Receipt number
Claim total:
Date to Newport:

2. Claim Amount and Certification

I claim £ from the Department for Environment, Food and Rural Affairs, being a payment for work funded by the Darwin Initiative for the year beginning 01 April 2017. I certify that, to the best of my knowledge and belief, the information is accurate, the expenditure has been properly incurredand that no other grant has been or will be claimed from Central Government or government agency towards these costs without the full knowledge and agreement of the Department.

I accept that the Department will retain 25%of the award for the final year, or£20,000, whichever is the greater,until the final report reviewis received to the Department’s satisfaction and that where the final claim is less than £20,000, the Department reserves the right to withhold funds from the penultimate claim.

Signed: Date:

To be completed by signatory authorised on the original Grant Acceptance Form or notified to the Department thereafter

3. Contact Details – Who should we contact if we have queries about the information on this claim form?

Name: Position

Telephone number:E-mail:

Address:

Confirmation of bank details

(only required for International payments for grantees who do not have a UK bank account)

Bank name:Bank Address:

Your Bank account Number:Your Bank IBAN/Swift Code:

Payments are normally in GBP. Please advise if you require a different currency:

Please attach any additional routing information to support the transfer

4. Changes – Please tick the box below if the details have changed since your last grant payment.

Signatory panel You must attach a new/amendment to signatory panel form[1]

Banking details You must attach a new supplier set-up form1

5.Staff

Please provide the actual total expenditure on employment of staff for the year, where funded under this year’s Darwin Initiative grant

Staff employed
(Provide name and position) / Date work commenced and finished in 2017/18 / Proportion of this time
spent on this work / Cost to Darwin
(£)
TOTAL (must match Staff Costs total in Section 6)
  1. Total Darwin Costs–please note that you should only include Darwin costs, not the total costs that may come from other sources

Current Year’s Costs / 2017/18
Grant
(£) / 2017/18
Total actual Darwin Costs (£) / Variance
% / Comments (please explain any variance )
Staff costs (from Section 5)
Consultancy Costs
Overhead Costs
Travel and subsistence
Operating Costs
Capital items (from Section 7)
Others (from Section 8)
Audit costs
Claimed So Far / Claim for
this period / Surrender Amount
TOTAL / A / B / C.. / D.. / E..

AThisshould match the total annual grant approved in the offer letter or agreed with the Department thereafter

BThis should be the actual costs incurred (the sum of the figures above)

C Amount already claimed for this financial year

DEither A or B(whichever is the lesser amount) minus C. This is the figure that should appear in Section 2

EAny balance of funds will be assumed surrendered to Defra.

  1. Capital items

Please provide a description of all the capital items funded under this year’s Darwin Initiative grant (including costs and their location)

Capital items – description / Capital items - location / Capital items – cost (£)
TOTAL (Must match Capital items total in Section 6)
  1. Others

Please provide a description of the ‘other’ items funded under this year’s Darwin Initiative grant (including costs)

Other items – description / Other items – cost (£)
TOTAL (Must match Others total in Section 6)

03/2017

[1] These forms are available at