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FOR ENGLAND AND WALES
charity name
Foi the peiiod from (slart date)
Unre5trirted
funds
to the nÈare51
Restrictèd
fund5
lo the nearest
Elldowfflenl
funds
io the neare51
ToEal fund5
lasl year
to the neaiest
to. the nearest
A1 tte£eipts
Sub tolol
A2 Asset ond Investment Sales, et<
Tolol receipts
A3 Paymenls
Sub total
A4 Asset and investment purchases, etc
lotalpoyfflenls
Nef ol receipts/(poymenisJ
A5 Tr.onsleTS between funds
A6 Cash funds last yeai end
C05h lunds thi5 yeor end

'.5ection B"
- staternent of assets and. liabilili.es at the_end. o"f"the..pqiiod
Unrestricted
fuDIi5
to the tkearest
Restricted
funds
to the nearest
Endtswment
lufids
to the nearest
Details
Bl Cash funds
lotu
cos
un
{ogKee baldnces with weipts ondpoyrneTrtS QCCOUfjt(sJJ
Unrestri(ied
luftds
to the neare
Restricted
funds
Endowment
lufids
10 the ne3rp51
the neaiesl
Delails
IB2 Qther fflonelary0¥sels
Fund to which
assei belong5
C05t
(oplional)
Cuirenl value
<oplionol}
Delails
B3 Investment assets
Fund io which
asset belongs
Cost
(optional)
Current value
(optional}
Details
B4 Assets fetained for the thasltvs own use
Fund to which
Afflount due
(optional)
When due
(optionall
Details
85 Llabllltlos
Signed by one 01 two Iiustee5 on behalf
of all thè Iruslees
Signature
Piint name
Dale ol approval
13