Community Development Fund
Accountability Report Form
Triennial Grant Application
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. Your Organisation
Organisation Name
Name and Location
of Project/Service
(for which you received
funding)
Date Grant Approved
Date of Project/Service
Describe your project and the success of the project/service
How many people participated?
How did your Organisation benet?
How did the Waitomo District benet?
How did you assess these benets?
This Accountability Form must be completed and returned to Waitomo District Council at the
end of the nancial year. Please include a copy of the relevant years nancial report.
247079 : CDF7 : P1/2
2. Project Income and Expenditure
How was the Waitomo District Council support acknowledged by your Organisation?
The grant was spent as follows: (Summary of project income and expenditure)
Please provide evidence of expenditure (receipts/invoices)
Income
Contributions and Income
Expenditure
Cost of the Project
Please explain any difference between the project/service gures on this form and the gures entered on
the application form.
I solemnly declare that all details contained in this report are true and correct to the best of
my knowledge and that we have the authority to provide this information on behalf of our
organisation.
Name
Signature
Position
Date
3. Declaration
$ $
Email
Phone No
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