**31/7/24** 


## **Trustees’ Annual Report for the period** 

**From 1 /8/23                  Period start date   To Period end date** 

## **Charity name: Auti-Ms** 

## **Charity registration number: 1185467** 

## **Objectives and Activities** 

||SORP reference||
|---|---|---|
|Summary of the purposes of<br>the charity as set out in its<br>governing document|Para 1.17|**To support autistic women and girls. To**<br>**educate about the differences**<br>**experienced by autistic females**<br>**compared to male peers**|
|Summary of the main<br>activities in relation to those<br>purposes for the public<br>benefit, in particular, the<br>activities, projects or services<br>identified in the accounts.|Para 1.17 and<br>1.19|**Online support group**<br>**Dance workshops**<br>**Arts and craft workshops**<br>**Website**<br>**Social media information**|
|Statement confirming<br>whether the trustees have<br>had regard to the guidance<br>issued by the Charity<br>Commission on public<br>benefit|Para 1.18|**Yes- all trustees have**regard to the<br>guidance issued by the Charity Commission<br>on public benefit.|



**Additional information (optional)** You may choose to include further statements where relevant about: 

||SORP reference||
|---|---|---|
|Policy on grant making|Para 1.38|**We do not give grants**|
|Policy on social investment<br>including program related<br>investment|Para 1.38|**We do not invest**|
|Contribution made by<br>volunteers|Para 1.38|**Our charity is 100% run by volunteers**<br>**who give up their time. Without our**<br>**volunteers there would be no auti-ms**|
|Other|||





## **Achievements and Performance** 

||SORP reference||
|---|---|---|
|Summary of the main<br>achievements of the charity,<br>identifying the difference the<br>charity’s work has made to<br>the circumstances of its<br>beneficiaries and any wider<br>benefits to society as a<br>whole.|Para 1.20|**Through holding our adult online support**<br>**group we have established a supportive**<br>**social network for many autistic women**<br>**who otherwise would not be able to gain**<br>**the support of others who have similar**<br>**life experiences and would be socially**<br>**isolated.**<br>**Our face to face groups such as dance or**<br>**sewing give autistic women and girls a**<br>**chance to “ find their tribe” whilst also**<br>**learning new skills and hobbies. For**<br>**many of our girls, these activities are the**<br>**only times they are able to “be**<br>**themselves” and not feel judged by their**<br>**peers. It also helps them to build a social**<br>**network with others with similar**<br>**experiences and difficulties.**|



## **Additional information (optional)** You may choose to include further statements where relevant about: 

|Achievements against<br>objectives set|Para 1.41|**We have supported many autistic women**<br>**and girls this year as per our aims.**<br>**We have also spoken at conferences to**<br>**educate about the difficulties autistic**<br>**girls face as per our aims.**|
|---|---|---|
|Performance of fundraising<br>activities against objectives<br>set|Para 1.41|**Many of our users have raised funds for**<br>**us through activities such as raffles and**<br>**running marathons.**|
|Investment performance<br>against objectives|Para 1.41|**N/A**|
|Other||**N/A**|





## **Financial Review** 

|**Financial Review**|||
|---|---|---|
|Review of the charity’s<br>financial position at the end<br>of the period|Para 1.21|**£11,890**|
|Statement explaining the<br>policy for holding reserves<br>stating why they are held|Para 1.22|**Reserves are held to pay for the costs of**<br>**the website and to provide further**<br>**activities in the next financial year should**<br>**more funding not be available.**|
|Amount of reserves held|Para 1.22|**£6363**|
|Reasons for holding zero<br>reserves|Para 1.22|**N/A**|
|Details of fund materially in<br>deficit|Para 1.24|**N/A**|
|Explanation of any<br>uncertainties about the<br>charity continuing as a going<br>concern|Para 1.23|**N/A**|



**Additional information (optional)** You may choose to include further statements where relevant about: **Grants and fundraising by users** The charity’s principal sources of funds (including Para 1.47 any fundraising) **N/A** Investment policy and objectives including any Para 1.46 social investment policy adopted **Lack of volunteers to  support delivery Lack of funding .** A description of the principal Para 1.46 risks facing the charity Other 



## **Structure, Governance and Management** 

|Description of charity’s<br>trusts:|||
|---|---|---|
|Type of governing document<br>(trust deed, royal charter)|Para 1.25||
|How is the charity<br>constituted?<br>(e.g unincorporated<br>association, CIO)|Para 1.25|**Registered charity**|
|Trustee selection methods<br>including details of any<br>constitutional provisions e.g.<br>election to post or name of<br>any person or body entitled<br>to appoint one or more<br>trustees|Para 1.25|**Elected during AGM by attendees**|



**Additional information (optional)** You may choose to include further statements where relevant about: Policies and procedures adopted for the induction and Para 1.51 training of trustees The charity’s organisational structure and any wider Para 1.51 network with which the charity works Relationship with any related Para 1.51 parties Other 

## **Reference and Administrative details** 

|Charity name|Auti-Ms|
|---|---|
|Other name the charity uses||
|Registered charity number|1185467|
|Charity’s principal address|47 Wells Close<br>Long Ashton<br>Bristol|
|||





## **Names of the charity trustees who manage the charity** 

|1<br>2<br>3<br>4<br>5<br>6<br>7<br>8<br>9<br>10<br>11<br>12<br>13<br>14<br>15<br>16<br>17<br>18<br>19<br>20|**Trustee name**|**Office (if any)**|**Dates acted if not for whole**<br>**year**|**Name of person (or body) entitled**<br>**to appoint trustee (if any)**|
|---|---|---|---|---|
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– Corporate trustees names of the directors at the date the report was approved 

**Director name** 

Name of trustees holding title to property belonging to the charity 

**Trustee name Dates acted if not for whole year** 



## **Funds held as custodian trustees on behalf of others** 

Description of the assets held in this capacity 

Name and objects of the charity on whose behalf the assets are held and how this falls within the custodian charity’s objects 

Details of arrangements for safe custody and segregation of such assets from the charity’s own assets 

## **Additional information (optional)** 

## **Names and addresses of advisers (Optional information)** 

**Type of Name Address adviser** 

**Name of chief executive or names of senior staff members (Optional information)** 

## **Exemptions from disclosure** 

Reason for non-disclosure of key personnel details 

## **Other optional information** 



## **Declarations** 

**The trustees declare that they have approved the trustees’ report above.** 

**Signed on behalf of the charity’s trustees** 

**Signature(s) Full name(s) Position (eg Secretary, Chair, etc) Date** 



~ ~ 

1334 

||**Charity Name**<br><br>**Auti-Ms**<br>|**Charity Name**<br><br>**Auti-Ms**<br>|**Charity Name**<br><br>**Auti-Ms**<br>|**No**<br>**1185467**|**CC16a**|
|---|---|---|---|---|---|
||**Receipts andpayments accounts**|||||
||**For the period**<br>**from**|Period start date<br>**###**|**To**|Period end date<br>**###**||
|||||||
|**Section A Receipts and payments**||||||
|**A1 Receipts**|**to the nearest £**<br>**Unrestricted**<br>**funds**|**to the nearest £**<br>**Restricted**<br>**funds**|**to the nearest £**<br>**Endowment**<br>**funds**|**Total funds**<br>**to the nearest £**|**Last year**<br>**to the nearest £**|
|Grantsprovided byother charities||**-**|**-**|||
|website development|||||**9,100**|
|For specificprojects||**1,187**|||**1,560**|
|Generalgrants||||||
|Donations andgifts|**3,887**||**-**||**100**|
|Dontatedgoods,facilities and other services||||||
|**_Sub total_**_(Gross income for AR)_|**3,887**<br>|**1,187**|**-**|**5,074**|**10,760**|
|**A2 Asset and investment sales(see table)**||||||
|Not applicable|**-**|**-**|**-**|**-**|**-**|
|**_Sub total_**|**-**|**-**|**-**|**-**|**-**|
|**_Total receipts_**<br>**A3 Payments**||||||
||**3,887**|**1,187**|**-**|**5,074**|**10,760**|
|||||||
|Rasingfunds||**-**|**-**|||
|Charitable activities||**-**|**-**|||
|Utilities andgeneral runningcosts(includingwebsite<br><br><br>|**106**|**1,562**|**-**||**3,749**|
|Raisingawareness and runningworkshops<br>~~d~~<br>~~l~~<br>~~)~~||**2,636**|**-**||**5,410**|
|Trainingfor volunteers|||**-**||**500**|
|**_Sub tota_**|**_l_                       106**|**4,198**|**-**|**4,304**|**9,659**|
|**A4 Asset and investmentpurchases, (see table)**||||||
|Not applicable|**-**|**-**|**-**|**-**||
|**_Sub tota_**|**_l_**||**-**|||
|**_Total payments_**<br>**_Net of receipts/(payments)_**<br>**A5 Transfers between funds**<br>**A6 Cash funds last year end**<br>**_Cash funds this year end_**||||||
||**106**|**4,198**||**4,304**|**9,659**|
|||||||
||**3,781**|**-                  3,011**|||**1,101**|
|||||||
||**2,582**|**8,538**||**11,120**|**10,019**|
||**6,363**|**5,527**||**11,890**|**11,120**|
|||||||



## **Section B Statement of assets and liabilities at the end of the period** 

**B1 Cash funds** 

**B2 Other monetary assets B3 Investment assets** 

**B4 Assets retained for the charity’s own use** 

## **B5 Liabilities** 

Signed by one or two trustees on behalf of all the trustees 

|**Details**|**to nearest £**<br>**Unrestricted**<br>**funds**|**to nearest £**<br>**Restricted**<br>**funds**|**to nearest £**<br>**Endowment**<br>**funds**|
|---|---|---|---|
|Cash at bank|**6,363**|**5,527**|**-**|
|**Details**<br>**_Total cash funds_**|**6,363**|**5,527**|**-**|
|||||
||**Unrestricted**<br>**funds**|**Restricted**<br>**funds**|**Endowment**<br>**funds**|
|Not applicable|**-**|**-**|**-**|
|**Details**|**Fund to which**<br>**asset belongs**|**Cost (optional)**|**Current value**<br>**(optional)**|
|Not applicable|**-**|**-**|**-**|
|**Details**|**Fund to which**<br>**asset belongs**|**Cost (optional)**|**Current value**<br>**(optional)**|
|Not applicable|**-**|**-**|**-**|
|**Details**|**Fund to which**<br>**liability relates**|**Amount due**<br>**(optional)**|**When due**<br>**(optional)**|
|Not applicable|**-**|**-**|**-**|
|Signature|Print|Name|Date of approval|
|A L Gregory|Anne Lorrai|ne Gregory||
|G Oxley|Gabriell|e Oxley||





|**Date**|**GL**<br>**Acct**<br>**Descripton**|**GL**<br>**Acct**<br>**Descripton**|**GL**<br>**Acct**<br>**Descripton**|
|---|---|---|---|
|||||
|12 Aug20|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 Aug20|100|Cash|Payment for Zoom|
|01 Sep20|300|Grants expenditure - restricted|Payment for website|
|01 Sep20|100|Cash|Payment for website|
|10 Sep20|300|Grants expenditure - restricted|EB Businessplanning|
|10 Sep20|100|Cash|EB Businessplanning|
|14 Sep20|600|Charitable activities - raisingawareness|Payment for Zoom|
|14 Sep20|100|Cash|Payment for Zoom|
|07 Oct 20|300|Grants expenditure - restricted|Payment to Voscur|
|07 Oct 20|100|Cash|Payment to Voscur|
|12 Oct 20|300|Grants expenditure - restricted|Recruitingtrustee|
|12 Oct 20|100|Cash|Recruitingtrustee|
|12 Oct 20|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 Oct 20|100|Cash|Payment for Zoom|
|12 Nov 20|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 Nov 20|100|Cash|Payment for Zoom|
|20 Nov 20|100|Cash|Charitable receipt from BT PG|
|20 Nov 20|400|Donations andgifts|Charitable receipt from BT PG|
|07 Dec 20|900|Charitable activities -general runningcosts|PolicyBee insurance|
|07 Dec 20|100|Cash|PolicyBee insurance|
|14 Dec 20|600|Charitable activities - raisingawareness|Payment for Zoom|
|14 Dec 20|100|Cash|Payment for Zoom|
|12Jan 21|600|Charitable activities - raisingawareness|Payment for Zoom|
|12Jan 21|100|Cash|Payment for Zoom|
|02 Feb 21|300|Grants expenditure - restricted|Trainingcosts|
|02 Feb 21|100|Cash|Trainingcosts|
|12 Feb 21|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 Feb 21|100|Cash|Payment for Zoom|
|22 Feb 21|100|Cash|Donation from Lea-Wilson|
|22 Feb 21|400|Donations andgifts|Donation from Lea-Wilson|
|09 Mar 21|600|Charitable activities - raisingawareness|"UsingLinkedIn"|
|09 Mar 21|100|Cash|"UsingLinkedIn"|
|10 Mar 21|300|Grants expenditure - restricted|"EB Small Charity"|
|10 Mar 21|100|Cash|"EB Small Charity"|
|12 Mar 21|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 Mar 21|100|Cash|Payment for Zoom|
|18 Mar 21|100|Cash|Donation|
|18 Mar 21|400|Donations andgifts|Donation|
|18 Mar 21|100|Cash|Donation|
|18 Mar 21|400|Donations andgifts|Donation|
|22 Mar 21|300|Grants expenditure - restricted|"JKP UK"|
|22 Mar 21|100|Cash|"JKP UK"|
|12 Apr 21|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 Apr 21|100|Cash|Payment for Zoom|
|22 Apr 21|600|Charitable activities - raisingawareness|Canvagraphic design|
|22 Apr 21|100|Cash|Canvagraphic design|
|29 Apr 21|300|Grants expenditure - restricted|Trainingcosts|
|29 Apr 21|100|Cash|Trainingcosts|
|12 May21|600|Charitable activities - raisingawareness|Payment for Zoom|
|12 May21|100|Cash|Payment for Zoom|
|21 May21|100|Cash|Maingrants|
|21 May21|800|Grants income - restricted|Maingrants|
|14Jun 21|600|Charitable activities - raisingawareness|Payment for Zoom|
|14Jun 21|100|Cash|Payment for Zoom|
|16Jun 21|300|Grants expenditure - restricted|The Autism Show|
|16Jun 21|100|Cash|The Autism Show|
|25Jun 21|100|Cash|Grant - Inclusion Gloucestershire|
|25Jun 21|800|Grants income - restricted|Grant - Inclusion Gloucestershire|
|29Jun 21|300|Grants expenditure - restricted|Web design cost|
|29Jun 21|100|Cash|Web design cost|
|12Jul 21|600|Charitable activities - raisingawareness|Zoompayment - used for workshops inyear|





|12Jul 21|100|Cash||
|---|---|---|---|
|16Jul 21|300|Grants expenditure - restricted|Trans inclusion training|
|16Jul 21|100|Cash||
|30Jul 21|300|Grants expenditure - restricted|Website cost - use ofgrant|
|30Jul 21|100|Cash||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
|||n/a||
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|**Debit**<br>**Credit**<br>**Futher notes**|**Debit**<br>**Credit**<br>**Futher notes**|**Debit**<br>**Credit**<br>**Futher notes**|
|---|---|---|
||||
|14.39|||
||14.39||
|12.46||12.46|
||12.46|12.46|
|5.00|||
||5.00||
|14.39|||
||14.39||
|55.00|||
||55.00||
|5.00|||
||5.00||
|14.39|||
||14.39||
|14.39|||
||14.39||
|40.00|||
||40.00||
|84.00|||
||84.00||
|14.39|||
||14.39||
|14.39|||
||14.39||
|46.00|||
||46.00||
|14.39|||
||14.39||
|100.00|||
||100.00||
|10.00|||
||10.00||
|5.00|||
||5.00||
|14.39|||
||14.39||
|52.50|||
||52.50||
|22.60|||
||22.60||
|35.00|||
||35.00||
|14.39|||
||14.39||
|0.99|||
||0.99||
|5.77|||
||5.77||
|14.39|||
||14.39||
|7,670.00|||
||7,670.00||
|14.39|||
||14.39||
|38.30|||
||38.30||
|2,000.00|||
||2,000.00||
|360.00|||
||360.00||
|14.39|||





14.39 10.00 - 10.00 12.46 - 12.46 - - - - - - - - - - - - - - - - - - - - - - 



**Sub category for notes** Payment for website under the £2,000 grant Training event with the small charities coalition on mental health training - out of the restricted grant for training & website Training was for mental health signposting.EB is Eventbrite who take the bookings. Training was for mental health signposting.EB is Eventbrite who take the bookings. Training Payment for Zoom "Charitable giving, courtesy of BT PG" "Charitable giving, courtesy of BT PG" NAS Women & girls conference - training "Using LinkedIn" - This  was for 2 of our trustees to join a regional networking meeting with the aim to raise our profile and link with similar charities in the locality. "Using LinkedIn" Group training activity Group training activity Group training activity Group training activity Canva - graphic design Training for facilitating a support group with participants who may not have stable mental health Training for facilitating a support group with participants who may not have stable mental health "The autism show" "The autism show" Inclusion Gloucest - is this a restricted grant? Inclusion Gloucest - is this a restricted grant? Elimelight web design - Bristol Elimelight web design - Bristol 



|**Transacton number**<br>**Query/ notes**|**Transacton number**<br>**Query/ notes**|
|---|---|
|||
|1||
|1||
|2||
|2||
|3||
|3||
|4||
|4||
|5||
|5||
|6||
|6||
|7||
|7||
|8||
|8||
|9||
|9||
|10||
|10||
|11||
|11||
|12||
|12||
|13||
|13||
|14||
|14||
|15||
|15||
|16||
|16||
|17||
|17||
|18||
|18||
|19||
|19||
|20||
|20||
|21||
|21||
|22||
|22||
|23||
|23||
|24||
|24||
|25||
|25<br>||
|26|Grant for a specifc social skills project, as yet unspent|
|26||
|27||
|27||
|28||
|28||
|29|Restricted to training and website development cost|
|29||
|30||
|30||
|31||





31 32 32 33 33 34 34 35 35 36 36 37 37 38 38 39 39 40 40 41 41 42 42 43 43 44 44 



|**600**<br>**Charitable actvites - raising awareness**|**600**<br>**Charitable actvites - raising awareness**|**600**<br>**Charitable actvites - raising awareness**|**900**<br>**Charitable actvites -general running costs**|
|---|---|---|---|
|14.39<br>14.39<br>14.39<br>14.39<br>14.39<br>10.00<br>14.39<br>10.00<br>14.39<br>14.39<br>0.99<br>14.39<br>14.39<br>14.39|||84.00|
|||||
|||||
|14.39||||
|||||





|**800**<br>**Grants income - restricted**|**800**<br>**Grants income - restricted**|**100**<br>**Cash**|**100**<br>**Cash**|**100**<br>**Cash**|**50**<br>**Raising**|
|---|---|---|---|---|---|
|-<br>-|7,670.00<br>2,000.00|2,827.33||||
|||-<br>-<br>-<br>-<br>-<br>-<br>-<br>-<br>40.00<br>-<br>-<br>-<br>-<br>-<br>100.00<br>-<br>-<br>-<br>52.50<br>22.60<br>-<br>-<br>-<br>-<br>-<br>7,670.00<br>-<br>2,000.00<br>-<br>-<br>-<br>-|14.39<br>12.46<br>55.00<br>5.00<br>14.39<br>14.39<br>14.39<br>14.39<br>-<br>84.00<br>14.39<br>14.39<br>46.00<br>14.39<br>-<br>10.00<br>5.00<br>14.39<br>-<br>-<br>35.00<br>14.39<br>0.99<br>5.77<br>14.39<br>-<br>38.30<br>-<br>360.00<br>14.39<br>10.00<br>12.46|||
|||||||
|||||||
|||-|5.00|||
|||||||
|||12,712.43|857.66|||
|||||||





|**00**<br>**g funds**|**300**<br>**Grants expenditure - restricted**|**300**<br>**Grants expenditure - restricted**|**300**<br>**Grants expenditure - restricted**|**700**<br>**Errors/ double charges**|**700**<br>**Errors/ double charges**|
|---|---|---|---|---|---|
||12.46<br>5.00<br>55.00<br>5.00<br>35.00<br>5.77<br>38.30<br>360.00<br>10.00<br>12.46|||||
|||||||
||46.00<br>5.00|||||
|||||||





|**200**<br>**Donatedgoods, facilites and other services**|**200**<br>**Donatedgoods, facilites and other services**|**400**<br>**Donatons andgifs**|**400**<br>**Donatons andgifs**|
|---|---|---|---|
|||-<br>-<br>-<br>-|40.00<br>100.00<br>52.50<br>22.60|
|||||



215.10 



||**Charity Name**<br><br>**Auti-Ms**<br>|**Charity Name**<br><br>**Auti-Ms**<br>|**Charity Name**<br><br>**Auti-Ms**<br>|**No**<br>**1185467**|**CC16a**|
|---|---|---|---|---|---|
||**Receipts andpayments accounts**|||||
||**For the period**<br>**from**|Period start date<br>**###**|**To**|Period end date<br>**###**||
|||||||
|**Section A Receipts and payments**||||||
|**A1 Receipts**|**to the nearest £**<br>**Unrestricted**<br>**funds**|**to the nearest £**<br>**Restricted**<br>**funds**|**to the nearest £**<br>**Endowment**<br>**funds**|**Total funds**<br>**to the nearest £**|**Last year**<br>**to the nearest £**|
|Generalgrantsprovided byother charities|**4,424**|**-**|**-**|**4,424**|**-**|
|Donations andgifts|**317**|**-**|**-**|**317**|**-**|
|Dontatedgoods,facilities and other services|**90**|**-**|**-**|**90**|**-**|
|**A2 Asset and investment sales(see table)**<br>**_Sub total_**_(Gross income for AR)_|**4,831**<br>|**-**|**-**|**4,831**|**-**|
|||||||
|Not applicable|**-**|**-**|**-**|**-**|**-**|
|**_Sub total_**|**-**|**-**|**-**|**-**|**-**|
|**_Total receipts_**<br>**A3 Payments**||||||
||**4,831**|**-**|**-**|**4,831**|**-**|
|||||||
|Rasingfunds|**133**|**-**|**-**|**133**|**-**|
|Charitable activities|**-**|**-**|**-**|**-**|**-**|
|Utilities andgeneral runningcosts|**701**|**-**|**-**|**701**|**-**|
|Raisingawareness|**1,169**|**-**|**-**|**1,169**|**-**|
|**_Sub tota_**|**_l_                    2,004**|**-**|**-**|**2,004**|**-**|
|**A4 Asset and investmentpurchases, (see table)**||||||
|Not applicable|**-**|**-**|**-**|**-**||
|**_Sub tota_**|**_l_                          -**|**-**|**-**|**-**|**-**|
|**_Total payments_**<br>**_Net of receipts/(payments)_**<br>**A5 Transfers between funds**<br>**A6 Cash funds last year end**<br>**_Cash funds this year end_**||||||
||**2,004**|**-**|**-**|**2,004**|**-**|
|||||||
||**2,827**|**-**|**-**|**2,827**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**2,827**|**-**|**-**|**2,827**|**-**|



## **Section B Statement of assets and liabilities at the end of the period** 

|**B1 Cash funds**<br>**B2 Other monetary assets**<br>**B3 Investment assets**<br>**B4 Assets retained for the charity’s own use**<br>**B5 Liabilities**<br>Signed by one or two trustees on behalf of all the trustees|**Details**|**to nearest £**<br>**Unrestricted**<br>**funds**|**to nearest £**<br>**Restricted**<br>**funds**|**to nearest £**<br>**Endowment**<br>**funds**|
|---|---|---|---|---|
||Cash at bank|**2,827**|**-**|**-**|
||**Details**<br>**_Total cash funds_**|**2,827**|**-**|**-**|
||||||
|||**Unrestricted**<br>**funds**|**Restricted**<br>**funds**|**Endowment**<br>**funds**|
||Not applicable|**-**|**-**|**-**|
||**Details**|**Fund to which**<br>**asset belongs**|**Cost (optional)**|**Current value**<br>**(optional)**|
||Not applicable|**-**|**-**|**-**|
||**Details**|**Fund to which**<br>**asset belongs**|**Cost (optional)**|**Current value**<br>**(optional)**|
||Not applicable|**-**|**-**|**-**|
||**Details**|**Fund to which**<br>**liability relates**|**Amount due**<br>**(optional)**|**When due**<br>**(optional)**|
||Not applicable|**-**|**-**|**-**|
||Signature|Print|Name|Date of approval|
||||||
||||||



