REPORT ON THE USE OF SPONSORSHIP

Date of submitting the report:

1. INFORMATION ON THE DONEE AND AGREEMENT

1.1.Name and code of the Donee
1.2.Name of project /activity
1.3.Application registration number
1.4.Date of signing the agreement, number
1.5.Start date of the project /activity
1.6.Finish date of the project /activity
1.7.Total amount of the project / activity / EUR
1.8.Amount allocated by the LietuvosEnergija Sponsorship Fund / EUR
1.9. Used amount of the funds allocated by LietuvosEnergija Sponsorship Fund / EUR

2. INFORMATION ON IMPLEMENTATION OF THE PROJECT/ACTIVITY

  1. Briefly describe the project/activity for which the sponsorship was used (not more than 1,000 characters)

2.1.
2.2.Provide information on implemented activities, project stages, and achieved indicators
Indicate all intended activities and achieved indicators in separate lines.
Activity/Project stages / Value planned to be achieved / Actually achieved value / Achievement date / Notes and commentaries
2.3. Describe the benefit and value for society, region, target audiences, indirect beneficiaries, etc.(not more than 1,000 characters)
2.4. Indicate how the project/activity was managed – how many persons participated in the project management, supervision, how project /activity deadlines, budget, publicity measures, and transparency of using the sponsorship were managed. (not more than 1,000 characters)
2.5. Provide information on the project/activity implementation partners.(not more than 1,000 characters)
2.6. Continuity of the project/activity. (not more than 1,000 characters)
Indicate whether the project/activity were of short-time nature or continuing. If it is planned to continue the project/activity, briefly provide information on its continuity – planned measures, assurance of continuity, financing, etc.
  1. PROJECT/ACTIVITY BUDGET

3.1.Please provide detailed information on the use of the Fund’s financing
Itemize separately the total budget of the part financed by the Fund.
Title of expenditure line / Planned amount of expenditures / Actually used amount of expenditures / Notes and commentaries
EUR / EUR
Amount, in total:
  1. IMPLEMENTATION OF PUBLICITY PLAN

4.1. Briefly describe publicity measures for the project/activity and created benefit for raising awareness for LietuvosenergijaUAB,group of enterprises.(not more than 1,000 characters)
4.2 Specify measures used while implementing the publicity plan.
Indicate all used publicity measures, employee involvement projects, and other initiatives of raising awareness of LietuvosenergijaUAB, group of enterprises in separate lines.
Description of the publicity measure / Planned value / Actually achieved value / Achievement date / Notes and commentaries
  1. RISK MANAGEMENT

5. Please identify and describe all occurred and unforeseen events, changed risk circumstances, furnish other information that had an effect for the implementation of the project/activity, achievement of indicators, financing, etc. Please indicate the applied risk management measures.
  1. CONCLUSIONS, NOTES, SUGGESTIONS

7. ANNEXES [i]

The report on the use of the sponsorship should be followed by an audit certificate, also other documents in support of the performance of the agreement that have not been furnished with other reports (pictures/copies of articles/posters, itemized budget tables, and other information)

No. / Document title / Number of pages / Notes/commentaries

CONFIRMATION

BY SIGNING THIS REPORT THE APPLICANT CONFIRMS THAT:

1.1.Information furnished in this report is accurate and true;

1.2.The applicant is aware that if he uses the sponsorship not for the goals it has been allocated, the Donor may demand to pay back it under the procedure laid down in the legal acts and the sponsorship agreement.

Job title, name, surname of the head of the institution
Date
Signature

[i]When submitting a report on the use of the sponsorship, it is necessary to present a certificate of the audit conclusion (for applications the sponsorship exceeding EUR 15,000.00) and other documents, and data in support of the information indicated in the report. Upon failure to present documents and data in support of the information, the report shall be deemed to have been submitted with shortcomings and the Fund shall have the right to apply with the request to submit itrepeatedly.