Declaration and Undertaking. The Recipient declares that: it has read, understood and complied with all the conditions of the grant set out in the Funding Agreement to which this claim refers. the information on this form is correct to the best of its knowledge and belief and the Recipient accepts full responsibility for it. it undertakes that it will keep accounts, invoices and receipts for 6 years after the last date grant is paid in connection with this grant and make them available for inspection on request by GLA officers. it has taken delivery of and paid for all items for which it is claiming grant and the Recipient’s claim covers only the amounts spent on the items described in this form. The Recipient’s claim is for the net costs of the items, excluding VAT. it undertakes that it will notify the GLA immediately in writing or by email of any changes to the details provided in this form. This declaration must be signed by the Project Manager and the Recipient’s Chief Financial Officer which is making this claim. Signature Name in BLOCK letters Position Date (Project Manager) Recipient’s Chief Financial Officer Part C: Output Values Return Not applicable Schedule 7 Self-Evaluation Template Use this template where the Agreement contains Milestones requiring the Recipient to undertake post-Project delivery monitoring and evaluation. Use this template to evaluate the impacts and outcomes of the Project. The Recipient must, as a minimum, provide all of the information indicated below. Project Name and Summary Borough/Organisation Name GLA Project Manager Manager completing the self- evaluation Total GLA Funding for Project Total lifetime cost of Project Other public/private investment Actual Project start date Actual Project end date 1.0 Executive Summary 2.0 Methodology
Declaration and Undertaking. 3.1 The Parties consider themselves as clearing professionals and declare that they have the resources and expertise required to perform the terms of this Agreement.
Declaration and Undertaking. We declare that the project is being implemented in accordance with the Grant Agreement. • We undertake to notify the Council immediately in writing of any changes to detailed notes on this form and any attachments. • Evidence of spend (invoices, certificates of work) will kept and made available for inspection by the Council. Name (block capitals) Signature Date Supporting evidence for the second instalment of the Grant must be provided with this claim form to support the claim for funding.
Declaration and Undertaking. Previously Exchanged Contracts Do you or your Domestic Partner have any exchanged First Grant Contracts for Land Rent Leases? Yes No If Yes, please provide Block, Section and Estate details and the name of the purchasing entity. See page 1 for circumstances where the Application may be rejected. Statutory declaration – Applicant 1 APPLICATION FOR LAND RENT LEASE I, (full name) Being a (occupation) of (address) make the following declarations under the Statutory Declarations Act 1959 (Cth):
Declaration and Undertaking. I declare the information provided in this form is, to the best of my knowledge, accurate and complete. I undertake to notify the Administrator immediately and provide an updated self- certification form within 30 days should there be a change of circumstance which causes any of the information contained in this form to be inaccurate or incomplete. Where legally obliged to do so, I hereby consent to the recipient sharing this information with the relevant tax information authorities. Signature Date (MM/DD/YYYY) Name: PART G – ENTITY SELF-CERTIFICATION FORM This self-certification form (the ‘Form’) is to be completed by all legal entities including, for this purpose, companies, partnerships, trusts and foundations. The information on the Form is collected for any existing or future legislation enacted by any jurisdiction that provides for the automatic exchange of information including, without limitation, the Foreign Account Tax Compliance Act (FATCA) and the OECD common reporting standard for the automatic exchange of financial account information. Please note that in certain circumstances the Company and the Administrator may be obliged to share this information with relevant tax authorities. Terms referenced in this Form shall have the same meaning as applicable under the relevant IGA’s, applicable regulations and guidance notes. If any of the information below regarding your tax residency changes in the future you are obliged to notify the Company at the offices of the Administrator of these changes promptly. If you have any questions about how to complete this form, please contact your tax advisor.
Declaration and Undertaking. The Agent made due and proper enquiry of the Performer (or if no Agent is acting, the Performer has determined) whether there is anything in the Performer’s background or their personal or professional associations which might have adverse consequences for the Company or the Product when the Performance becomes public and the Agent (or the Performer as the case may be) represents that there is no valid reason why the Performer should not be engaged for this role. The Performer will not knowingly participate in any TV commercial for any products or brands in direct competition with the advertised products or brands, while the performance and the TV commercial the subject of this agreement remains current. NAME SIGNATURE DATE Agency on behalf of the Company: The Agent on behalf of the Performer
Declaration and Undertaking. The Recipient declares that: • it has read, understood and complied with all the conditions of the grant set out in the Funding Agreement to which this claim refers. • the information on this form is correct to the best of its knowledge and belief and the Recipient accepts full responsibility for it. • it undertakes that it will keep accounts, invoices and receipts for 10 years after the last date grant is paid in connection with this grant and make them available for inspection on request by GLA officers. • it has taken delivery of and paid for all items for which it is claiming grant and the Recipient’s claim covers only the amounts spent on the items described in this form. The Recipient’s claim is for the net costs of the items, excluding VAT. • it undertakes that it will notify the GLA immediately in writing or by email of any changes to the details provided in this form. This declaration must be signed by the Project Manager and the Recipient’s Chief Financial Officer which is making this claim. Signature Name in BLOCK letters Position Date (Project Manager) Recipient’s Chief Financial Officer Part C: Output Values Return
Declaration and Undertaking
