SOUTH WESTACADEMY OF SPORT

ACQUITTAL REPORT

  1. (a)SUMMARY INFORMATION

Name of Organisation:

Organisation

/ Postal Address:
Details / Telephone: Fax: Email:
Contact Person: Position: Date:

Sport Program

/ Sport Program Information:
Information / Description:
Actual Project Commencement Date / Actual Project
Completion Date
  1. (b)FINANCIAL SUMMARY

(All figures should be excluding GST and be the actual completion figures)

South West Academy of Sport Funds / $
Other Cash / $
Inkind / $
Total Project Cost / $

Forward completed forms to:South West Academy of Sport

PO Box696, BUNBURY, WA 6231

Ph: 08 9792 4504

CHECKLIST

The intention of the acquittal is to compare the actual outcomes (e.g. economic, social, financial, environment) to the original proposal. This includes project outcomes and benefits and financial aspects such as other partners, various incomes and how the money was spent compared to the proposed budget

Please make sure the following items have been addressed, completed and provided, otherwise the acquittal will either be returned or you will be requested to provide additional information

Have you:

Completed the acquittal document and had it signed by the appropriate person?

Checked you reported on each objective as detailed in original application?

Completed and attached the Statement of Income and Expenditure for the Project and had it signed by the appropriate person?

For grants of $20,000 or less:

South West Academy of Sport does not require an audited acquittal by an auditor, however, you are required to submit original invoices tax invoices or certified copies of tax invoices, detailing the expenses paid with the SWAS funding. Including a statement of income and expenditure for the budget, signed by the Chief Executive Officer/Chairperson (or equivalent) of the recipient organisation/association that show the budget was expended in accordance with the SWAS proposed budget and has been used for the purpose for which it was provided.

For grants over $20,000:

Details on how the funds were expended, including an audited financial statement or income expenditure for the project (prepared by a qualified independent auditor and signed by him/her), signed by the Chief Executive Officer (or equivalent) of the recipient organisation/association, that show the funding was expending in accordance with the SWAS proposed budget and has been used for the purpose of which it was provided.

Please contact the SWAS Program Coordinator should you have any queries about this process at or (08) 9792 4504

2. PROGRAMSUSTAINABILITY

Describe how the programwill be sustained and/or further developed in the future?

3. PROGRAM PARTNERSHIPS

Describe any partnerships formed during the program with the business sector, general community, or the various levels of Government.
(State the number of partnerships that were formed and name the organisations.)

4. FINANCIAL OBLIGATIONS

The South West Academy of Sport requires evidence showing grant funds were expended in accordance with the grant agreement made with the South West.

Pleaseensure that all requirements for financial obligations detailed in the grant agreement have been complied with and supplied.

  • You must provide:
  • Income and Expenditure Statement signed by the EO, Chairman or authorised officer.
  • Detail what the grant funds were expended on.
  • Detail in-kind including calculations.

5. INCOME AND EXPENDITURE

Please complete the table below OR attach an income and expenditure report for your project

INCOME - CASH / Actual amount received
$ GST Exclusive / $ GST
SWAS Grant Funding
Your Cash Contribution
Other Funding (list below, add more rows as required)
TOTAL CASH INCOME
EXPENDITURE - CASH / Actual amount spent
$ GST Exclusive / $ GST
Detail Items funded through South WestAcademy of Sport
(As per application, please list below, add more rows as required)
Detail Items funded through your cash contribution
(add more rows as required)
Detail Items funded through other cash contributions
(add more rows as required)
TOTALCASH EXPENDITURE

6. IN-KIND CONTRIBUTION

IN-KIND / Actual In-Kind
Subtotal
$ Value (ex GST)
Detail in-kind items contributed by your organisation
(add more rows as required)
Detail in-kind items contributed by other sources
(add more rows as required)
TOTAL IN-KIND VALUE

7. DECLARATION

I ______of ______

do hereby declare that the information provided in this report is a true and correct record of the acquittal of funds received through the South WestAcademy of Sport for the project as described.

Signed by …………………………..…….. this …….….. Day of ……………..…….. 20…..