Accountability Report Form
DC Tynan Trust
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
1. Organisation
Organisation Name
I / We
This Accountability Form must be completed and returned to Waitomo District Council within
two months of your projects completion.
being authorised parties of the above organisation hereby certify that the grant we received was spent
on the project approved and that any specic conditions associated with this grant have been met.
The project achieved the following objectives:
2. Project Objectives
3. Declaration
We solemnly declare that all details contained in this report are true and correct to the best
of our knowledge and that we have the authority to provide this information on behalf of our
organisation. We attach evidence of expenditure (i.e. signed Income and Expenditure
Statement) for the project completed by the authorised parties.
Name
Name
Signature
Designation
Designation
Date
Date
Signature
Please send completed applications to:
Waitomo District Council
PO Box 404
Te Kuiti 3941
Ph: 07 878 0800
Fax: 07 878 7771
247088 : CDF8 : P1
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