Financial Acquittal Form - Queensland Government

Sport and Recreation Disaster Recovery Program
Acquittal Form
This form is to be used for all projects funded through the Sport and Recreation Disaster Recovery Program
Section A: Organisation details
1 Organisation’s full legal name
2 Contact person
3 Job title
4 Telephone
5 Email
Section B: Project details
1 Project reference number
Z – 0 1 –
2 What is the total funding being acquitted?
$ –
Note: For projects approved funding in excess of $10,000 please complete the table at Appendix A. This acquittal amount should be GST exclusive
for organisations registered for GST and GST inclusive for organisations not registered for GST.
3 Was the funded project completed as agreed between the organisation and the department?
(Please tick one)
Yes
No
If No, please provide details of the project delivered:
Section C: Declaration
(Two (2) members of your organisation’s management committee must complete the details below).
We certify that our organisation has recorded and retained original invoices and receipts and expended the grant received from the Queensland Government
as detailed and in accordance with the terms and conditions of our Funding Agreement with the Queensland Government. We acknowledge that financial
records relating to this funding must be kept for a minimum of seven (7) years. We also acknowledge that the Queensland Government may audit the
organisation to verify the accuracy of the information contained in this acquittal.
Committee member 1 Committee member 2
Name:
Name:
Title:
Title:
Signature:
Signature:
Date:
Date:
Note: complete the Appendix (if applicable – refer to Section B) and attach to this declaration before submitting to Sport and Recreation Services.

Appendix A
1 If you were approved funding in excess of $10,000 please detail the total cost of your project below (include all invoices
relating to the expenditure):
Note: The costs included should be:
• GST exclusive for organisation registered for GST. Any refunds of funding will need to include the appropriate GST amount.
• GST inclusive for organisation not registered for GST. Any refund of funding should be the balance of the funding provided.
Eligible items
Final cost
Total costs – eligible items
(A)
Ineligible items
Final cost
Total cost – ineligible items
Total project cost
Total funding from SRS being acquitted
Total refund of funding
(B)
(A)+(B)
(C)
(D)
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