IMPORTANT: PLEASE ENSURE YOU GIVE YOUR GROUP NAME AND ACCOUNT NUMBER OR WE MAY BE UNABLE TO ACCEPT THE RETURN: Local Group Name: Bank account number: Group CIS number (office use): Statement of Receipts, Payments and Assets Receipts Total for 2016 ( ) 1 Donations 2 Grants 3 Legacies 4 Diabetes UK Sales 5 Other Sales 6 Bank Interest 7 Total Receipts (Sum of lines 1-6) Payments 8 Running costs and fundraising costs 9 Local activities and events 10 Diabetes UK merchandise for resale 11 Other purchases for resale 12 Diabetes UK Care Events, Holidays and Weekends 13 Other Diabetes UK events and conferences (attendance fees) 14 Other payments or donations Supporting the wider work of Diabetes UK 15 Total donations to Diabetes UK work 16 Total Payments (Sum of lines 8-15) Balances 17 Receipts over payments (7 minus 16) 18 Cash at bank at 1 January 2016 19 Cash in hand at 1 January 2016 20 Cash in hand & Bank balance at 31 December 2016 (add 17, 18 and 19) 21 Cash at Bank at December 2016 22 Cash in Hand at December 2016 23 Total Tick this box if no activities for year ended 31 st December 2016 Treasurer: (signature)... (Printed name).. Chair: (signature)... (Printed name) 1
Bank Reconciliation The Bank Reconciliation enables you to explain any discrepancies between the value on your bank statement and how much money the group actually has- this is usually due to cheques or deposits that have not yet cleared. Bank Name Account Number Bank sort code Balance as per bank statement 31 December 2016 1. Deposits not yet cleared Amounts banked (paid in) up to the 31 December 2016, but not yet on bank statement Date Paid In Source of Money Amount Subtotal A 2. Payments not yet cleared Cheques drawn (paid out) up to the 31 December 2016, but not yet on bank statement Date Cheque No. Payee Amount Subtotal B Bank balance (Statement total plus Subtotal A less Subtotal B- should be same as item 21 on Statement of Receipts, Payments and Assets) 2
Legacies received Legacies Received Name of Deceased Person(s) Amount (s) left to the Group Are there any restrictions on how the money is allowed to be used? If yes, what activity is the legacy restricted to? Please provide a copy of any documentation received with the Legacy, for audit purposes. 3
Information on grants and restricted donations received in year to 31 December 2016 Name of organisation/ company/individual Amount received Are there any restrictions on how the money can be used? If yes, what activities is the grant /donation restricted to? Please provide a copy of the documentation which outlines the restriction details. 4
Information on other payments made in year to 31 December 2016 Please give a breakdown and more detail on other payments or donations made as per item 14 on the Statement of Receipts, Payments and Assets. Name of organisation/ company/individual Amount of payment made ( ) What was the payment or donation for? TOTAL (equal to item 14) 5
Local Group Name: Bank account number: Group CIS number (office use): Supporting the wider work of Diabetes UK The Local Group Agreement states that Local Groups may hold up to 3,000 (or six months running costs, whichever is greater) in their bank account at the end of December each year. This is because we are legally bound to use the money we receive in line with the charities aims, and large amounts of monies should not be held in reserve. While we know many groups donate funds back to the core work of Diabetes UK each year, we understand that some groups are keen to fund local projects. Therefore we have produced a list of options of local projects and areas of work for each region or nation of the UK. Groups may also submit a proposal for planned activities for which excess funds are needed. Please complete this form below to let us know what you would like to do with excess funds over 3,000 in the group account at the end of 2016. 1. Excess held over 3,000:.. 2. Please chose appropriate option: I enclose a cheque and would like the funds to be spent on the following: General work of the organisation, not a specific area of work Improving care Supporting families Saving young lives Preventing Type 2 Diabetes Providing support when and how it s needed Raising Awareness Research The group would like to retain these funds to use on a planned activity. Your regional Volunteer Development Manager will contact you to discuss this option further 6