Please refer to your funding allocation letter FAL for by HC120708175759

VIEWS: 8 PAGES: 9

									           Date Received:




 Single Programme - Claim Form - Quarterly Claims
 Section 1 - Project Details


  Project Start Date:                                                                          Project End Date:

 Claim covering expenditure defrayed in period below:

      Allocation year:
                                                                                                                                        Interim:
Period covered from:                                                               to:                                                     Final:        Please tick or X as appropriate
                                                                                                                                   Outputs Only:




 Please refer to your funding allocation letter (FAL) for the following details:

        Project Name:

     Project Number:                                                                               Address of Applicant:


  Name of Proposer:

           Programme:
                                                                                                                 Postcode:
                 Activity:

    Activity Manager:

              NIL Claim:

 Contact person to whom queries can be made about this claim

                   Name:                                                                                                Tel:

                                                                                                                     Email:


        Name of bank:

               Address:                                                                                  Account Name:

                                                                                                               A/c Number:                                   Sort Code:     -      -

              Postcode:



                                                                                         ONE NORTH EAST FINANCE ONLY
                                                                                                      Sage Invoice Number:

                                                                                                               Creditor Code:

 Payment Details
 Expense Code (Grant Expenditure Category Claiming this quarter)                              Project Number                    Amount              VC
 PROG-                                                                                                                                                   3
 PROG-                                                                                                                                                   3
 PROG-                                                                                                                                                   3
 PROG-                                                                                                                                                   3
 PROG-                                                                                                                                                   3
 PROG-                                                                                                                                                   3

                                                              Amount certified for payment :                                                             3

 Comments:




   SHEET 1
Section 2: Expenditure Breakdown




Expenditure Claimed                                                                   Lifetime
                                                                              Cap                 Rev
                                a) Total Single Programme allocation:

                   b) Total Single Programme costs defrayed to date:

          c) Cumulative Single Programme costs previously claimed:

                              d) Eligible project costs this claim (b-c):           £0.00               £0.00




Certificate of Chief Financal Officer (for all external claims)

I hereby make an application for an Exchequer contribution towards the expenditure detailed overleaf.

                                I am claiming the following amount: £

I certify to the best of my knowledge and belief:

           a) the information given is correct and no other Exchequer specific grants, other grants or contributions have been or will be payable
           towards the expenditure in which this claim is made
           b) the expenditure has been defrayed
           c) the grant claimed is within the expenditure limit for grant, and complies with the conditions of project appraisal and approval
           d) the key outputs and outcomes expected to be delivered by the project at this stage have been met.


           Signature:                                                                               Position:


                 Name:                                                                                  Date:
           (BLOCK CAPITALS)




          Date received into office:




One North East Certification
I certify that I have examined this claim and that the items of expenditure were defrayed in accordance with the terms of the approval, are within
the approved sums, the arithmetic is correct, the payment has not previously been recommmended, and the advance is properly due, subject to
audit. Satisfactory progress has been made.


              Signature of certifying officer:

                                   Print name:

                                Date certified:



Authorisation (Refer to ONE's Financial Delegations )

            Signature of authorising officer:

                                   Print name:

                             Date authorised:




   SHEET 2
Section 3: Breakdown of funding
                                                                                                                        Current Year
                                        Previous years                April - June                    July - September                        Oct - Dec                         Jan - March                  Total      Forecast           Forecast               Total
                                                                                                                                                                                                            Outturn
                                                                                                                                                                                                           Forecast                                             Actual plus
Single Programme Funding                     Actual               Forecast          Actual           Forecast           Actual           Forecast          Actual           Forecast          Actual                    Next Year         Future Years
                                                                                                                                                                                                           Current                                               Forecast
                                                                                                                                                                                                             Year
Capital - Expenditure Category




                           Total Capital £            -       £         -       £        -       £          -       £        -       £         -       £        -       £         -       £        -       £    -       £     -       £             -       £             -
  Revenue - Expenditure Category




                          Total Revenue £             -       £         -       £        -       £          -       £        -       £         -       £        -       £         -       £        -       £    -       £     -       £             -       £             -

Total Single Programme                  £                 -   £             -   £            -   £              -   £            -   £             -   £            -   £             -   £            -   £        -   £         -   £                 -   £                 -

                                                                                                                        Current Year
Other Contributions                     Previous years                April - June                    July - September                        Oct - Dec                         Jan - March                  Total      Forecast           Forecast               Total
                                                                                                                                                                                                            Outturn
                                                                                                                                                                                                           Forecast                                             Actual plus
Private Sector Contributions                 Actual               Forecast          Actual           Forecast           Actual           Forecast          Actual           Forecast          Actual                    Next Year         Future Years
                                                                                                                                                                                                           Current                                               Forecast
                                                                                                                                                                                                             Year
Private Sector cash or
in kind

Other Non Public Sector cash or

In kind
Total Private Sector                    £                 -   £             -   £            -   £              -   £            -   £             -   £            -   £             -   £            -   £        -   £         -   £                 -   £                 -
                                                                                                                        Current Year
                                        Previous years                April - June                    July - September                        Oct - Dec                         Jan - March                  Total      Forecast           Forecast               Total
                                                                                                                                                                                                            Outturn
Public Sector Conts.                                                                                                                                                                                       Forecast                                             Actual plus
                                             Actual               Forecast          Actual           Forecast           Actual           Forecast          Actual           Forecast          Actual                    Next Year         Future Years
                                                                                                                                                                                                           Current                                               Forecast
                                                                                                                                                                                                             Year
Local Authority Funding
LSC
European Funding Objective 2
European Funding Objective 3
Other Public Sector (please specify)




Total Public Sector                     £                 -   £             -   £            -   £              -   £            -   £             -   £            -   £             -   £            -   £        -   £         -   £                 -   £                 -


Grand Total                             £                 -   £             -   £            -   £              -   £            -   £             -   £            -   £             -   £            -   £        -   £         -   £                 -   £                 -




     SHEET 3
Section 4: Future Deliverables Forecasts
For project approved after March 2009

Future Quarterly Output Forecast
                                                              =A+B+C+D                   A                                            B                                          C                         D
                                                                                                         Current Year                                 Next Year
                                                                  Project        Actuals
                           Output                                                                                                                                                     Future Years Total
                                                              Lifetime Target Previous Years   Q1   Q2      Q3          Q4   Total for yr   Q1   Q2    Q3         Q4   Total for yr

O1a        NTF1(i)     Jobs created
O1b        NTF1(ii)    Jobs safeguarded
O2(i)      NTF3(i)     Businesses created

O2(ii)     NTF3(ii)    Businesses attracted to the Region
O2(iii)    NTF3(iii)   Businesses surviving 12 months
O2(iv)     NTF3(iv)    Businesses surviving 24 months
O3         NTF4        Business Support
                       Businesses engaged in new
                       collaborations with the knowledge
O3(b)      NTF4(a)     base
O3(c)                  SME's assisted
                       Brownfield land reclaimed and/or
O4         NTF5a       redevloped
                       Individuals assisted towards getting
O5         NTF2        a job
                       Individuals assisted in their skills
O6         NTF6        development
O7(i)      NTF5 (i)    Total public sector leverage
                       European funding
                       Lottery funding
                       Income from project activity (£)
                       Local Authority Funding (£)
                       Other public sector funding (£)
O7(ii)     NTF5(ii)    Total private sector leverage
                       Business Accomodation Developed
O8                     (sqm)
O9                     RIS Marketing Activity
O9(a)                  Audiences Reached
O9(b)                  Ambassadors Created
O9(c)                  Events Held
O10                    Tourism Maketing Activity
O10(a)                 Audiences Reached
O10(b)                 Web-Site Visits
O11                    RIS & Tourism PR Activity
O11(a)                 Journalist visits
O11(b)                 Web-site visits
O11(c)                 Equivalent Advertising Coverage
O11(d)                 Tone and Content Indicator



Future Quarterly Outcome Forecast
                                                              =A+B+C+D                   A                                   B                                         C                                   D
                                                                                                         Current Year                                 Next Year
                                                                  Project        Actuals
                         Outcome                                                                                                                                                      Future Years Total
                                                              Lifetime Target Previous Years   Q1   Q2      Q3          Q4   Total for yr   Q1   Q2    Q3         Q4   Total for yr

OC1                    Jobs created/safeguarded
OC1a                   Jobs created
OC1b                   Jobs safeguarded
OC2(i)                 Businesses created

OC2(ii)                Businesses attracted to the Region
OC2(iii)               Businesses surviving 12 months
OC2(iv)                Businesses surviving 24 months
OC3                    Increased occupancy rates
OC4                    Improved regional connectivity
OC5                    People assisted who get a job

OC6                    People assisted remaining in work

                       Increased national and international
OC7                    awareness of the region

OC8                    Improved perception of the region
                       Increased number of day and
OC9                    overnight visitors to the region
Section 5: Future Deliverables Forecasts
For project approved betweem June 2005 and March 2009

Future Quarterly Output Forecast
                                                            =A+B+C+D                   A                                            B                                          C                         D
                                                                                                       Current Year                                 Next Year
                                                                Project        Actuals
                         Output                                                                                                                                                     Future Years Total
                                                            Lifetime Target Previous Years   Q1   Q2      Q3          Q4   Total for yr   Q1   Q2    Q3         Q4   Total for yr

O1a       NTF1(i)    Jobs created
O1b       NTF1(ii)   Jobs safeguarded
O2(i)     NTF3(i)    Businesses created

O2(ii)    NTF3(ii)   Businesses attracted to the Region
O2(iii)   NTF3(iii) Businesses surviving 12 months
O2(iv)    NTF3(iv) Businesses surviving 24 months
O3        NTF4     Business Support
                     Businesses engaged in new
                     collaborations with the knowledge
O3(b)     NTF4(a)    base
O3(c)                SME's assisted
                     Brownfield land reclaimed and/or
O4        NTF5a      redevloped
O5        NTF2       Individuals assisted to get a job
                     Individuals assisted in their skills
O6        NTF6       development
O7(i)     NTF5 (i)   Total public sector leverage
                     European funding
                     Lottery funding
                     Income from project activity (£)
                     Local Authority Funding (£)
                     Other public sector funding (£)
O7(ii)    NTF5(ii)   Total private sector leverage
                     Non-housing floorspace




SHEET 4
Section 6: Future Deliverables Forecasts
For project approved before June 2005

Future Quarterly Output Forecast
                                           =A+B+C+D                   A                                   B                                         C                             D
                                                                                      Current Year                                 Next Year
                                               Project        Actuals
 Code                   Output                                                                                                                                     Future Years
                                           Lifetime Target Previous Years   Q1   Q2      Q3          Q4   Total for yr   Q1   Q2    Q3         Q4   Total for yr

C1(i)     Jobs created (fte)
C1(ii)    Jobs safeguarded (fte)
C2(i)     Businesses created
C2(ii)    Busines Attracted
C2(iii)   Businesses surviving 12 months
C3        Learning Opportunities
C4        Bronwfield Land (ha)
C5        Private Investment
S1        Workforce Learning
S2        Universitt Spin-outs
S3        Broadband ICT Nodes
S4        Businesses supported/advised
S5        Non-housing Floorspace
S6        Learning Opportunities <30hrs




SHEET 5
Section 7: Progress on Key Milestones against Strategic Added Value
and Special Conditions
Please refer to your FAL for the details of these requirements

General Progress


Please report on the progress of the project against plan, including plans to recover non achievement. This should include comment
on the level of Single Programme Expenditure defrayed and other funding you have received elsewhere.

   Key Milestones/Deliverables Achieved and Forecast




   Strategic Added Value (SAV)




   Special Conditions




   General Progress




SHEET 6
Section 8: Form of the Auditors Report to be attached to final claim

     Headed paper of the independent auditor


     (Address the letter to One North East)


     Date



     I/we have examined the enclosed claim.



     I/we have examined the related accounts and records of the applicant and
     have carried out such tests as I/we consider necessary.



     I/we have obtained such explanations as I/we consider necessary.


     (Subject to the observations in the attached report) dated. Date


     I/we are of the opinion that the financial information and the level of grant
     claimed are fairly stated and that the expenditure has been properly defrayed
     in accordance with the offer letter dated.

     Date


     Name for enquiries:




SHEET 7

								
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