Public Record

PUBLIC RECORD

FORM A.R.5 No…………………...

FRIENDLY SOCIETIES ACT 1974

ANNUAL RETURN for

a SPECIALLY AUTHORISED SOCIETY,
a BENEVOLENT SOCIETY,

a CATTLE INSURANCE SOCIETY or

a SOCIETY registered for MEDICAL ASSISTANCE,
ASSISTANCE in case of SHIPWRECK, etc.

Year ended 31 December, ……………..

This Return is to be sent to the Registrar as soon as possible after 31 December, and, in any event, not later than 31 July. It should be accompanied by -

(1) A copy of the Auditor's Report (the space specifically provided on the back page may be used for this purpose).

(2) A copy of each Printed Account and Balance Sheet made up to a date within the period covered by the Return.

Name of Society (as registered) ………………………………………………………………………………………………………
Registered Office ……………………………………………………………………………………………………………………..
Date of Establishment of Society …………………………………………………………………………………………………….

Objects of Society ……………………………………………………………………………...

Note. This society *has/has not made use of the wider range investment powers conferred by the Trustee Investments Act
1961.

* Delete as appropriate.

NAMES AND ADDRESSES OF THE TRUSTEES AND THE COMMITTEE (in block letters)
AT THE DATE ………………………….…ON WHICH THE ANNUAL RETURN IS SIGNED.
Name / Address
Trustees
Committee (Chairman)
RETURN OF MEMBERS
*Number at the end of the year …………………………….

*In the case of a Benevolent Society insert the number subscribing during the year, including Life Members.

FOR OFFICIAL USE / Fee
Received / Ltr. / A/cs. / A.Rpt. / Ackd. / Entd. / Ab. / Ex. / R.C. / R.Pd.
1st
2nd

A – General Account

Income / £ / Expenditure / £
Contributions :-
For Management …………………...
For Benefits (if for various benefits,
each to be stated separately):-
Donations …………………………..
Entrance Fees ………………………
Fines ………………………………..
Interest on Investments (gross) …….
Other Income (to be specified):-
Total …….
Balance at beginning of year ………. / Benefits or Claims for Losses (each to be stated separately):-
……………………………………….
……………………………………….
……………………………………….
……………………………………….
……………………………………….
Interest on Loans ……………………
Expenses:-
Salaries or other remuneration:-
Secretary …………………………….
Treasurer …………………………….
Auditors ……………………………..
Other Officers (excluding Medical
Officers) …………………………….
Rent and Rates ………………………
Printing, Stationery and Postage ……
Other Expenses ……………………...
Depreciation of Investments and other
Assets ……………………………….
Other Expenditure (to be specified):-
……………………………………….
……………………………………….
……………………………………….
……………………………………….
……………………………………….
……………………………………….
Total ……
Balance at end of year as per Balance
Sheet (B) …………………………….
£ / £

B – Balance Sheet

£ / £
Amount of Funds for the several
purposes of the Society, as per
Account A (each to be stated
separately):-
General Reserve for
Depreciation ………………………..
Due to the Treasurer………………...
Other Liabilities (to be specified):- / Investments:
*Land and Buildings ………………
Freehold …………………………….
Leasehold ……………………………
Ground Rents, Rent Charges and Feu
Duties ……………………………….
Total …..
Mortgages on Land and Buildings
including (in Scotland) bonds on
heritable properties
British Government and British
Government Guaranteed Securities (to be specified):-
……………………………………….
……………………………………….
British Municipal and County
Securities (to be specified):-
……………………………………….
……………………………………….
Other Investments (to be specified):-
……………………………………….
……………………………………….
†Total Investments ………………….
Interest, Dividends and Rents accrued
and outstanding ……………………..
Balance at …………………………... Trustee Savings Bank
Balance at ……………………...Bank Cash in hand of Treasurer …………..
Do. Secretary …………………..
Other Assets (to be specified):-
……………………………………….
……………………………………….
£ / £

Notes
† Investments include £ ………………..in respect of quoted securities with a market value of £ …………... * Land and Buildings have been brought into account on the following basis

Signature of Trustee who hereby certifies to the investments shown in Balance Sheet …………………………
Signature to the Annual Return including the Account and Balance Sheet contained within the Annual Return:
Signature of member of Committee ………………………………………………………………………………
Signature of member of Committee ………………………………………………………………………………
Signature of Secretary …………………………………………………………………………………………….

AUDITOR'S REPORT

(In accordance with Section 38 of the Friendly Societies Act 1974)

Signature(s)………………………………………………………………………………………………………...
Profession(s) or Calling(s) ………………………………………………………………………………………….

Are you a Registered auditor? Yes/No*

(for the purposes of the Companies Act 1989) *Delete as appropriate

Address(es) …………………………………………………………………………………………………………

Address to which completed annual returns should be sent:

The FCA, Mutual Returns Team, 25 The North Colonnade, Canary Wharf, London E14 5HS