||**Action Collective**<br>|**Action Collective**<br>|**Action Collective**<br>|**No (if any)**|**CC16a**|
|---|---|---|---|---|---|
||**For the period**<br>**from**|3/31/2021|**To**|1/5/2022||
|||||||
|**Section A Receipts and payments**||||||
|**A1 Receipts**<br>£7,000<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**7,000**<br>**-**<br>**-**<br>**Sub total**<br>**#NAME?**<br>**Total receipts**<br>**#NAME?**<br>**A3 Payments**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**Sub total                               -**<br>**Unrestricted**<br>**funds**<br>**to the nearest      £**<br>**Sub total**(Gross income for AR)<br>**A2 Asset and investment sales,**<br>**(see table).**||**to the nearest £**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**Restricted**<br>**funds**|**to the nearest £**<br>**Endowment**<br>**funds**|**Total funds**<br>**to the nearest £**<br>**7,000**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**7,000**<br>**-**<br>**-**<br>**#NAME?**<br>**#NAME?**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**|**Last year**<br>**to the nearest £**|
||||**-**|**7,000**|**-**|
||||**-**|**-**|**-**|
||||**-**|**-**|**-**|
||||**-**|**-**|**-**|
||||**-**|**-**|**-**|
||||**-**|**-**|**-**|
||||**-**|**-**|**-**|
||||**-**|**-**|**-**|
||||**-**|**7,000**|**-**|
|||||||
||||**-**|**-**||
||||**-**|**-**|**-**|
||||**-**|**#NAME?**|**-**|
|||||||
||||**-**||**-**|
|||||||
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
||**-**|**-**|**-**|**-**|**-**|
|**Sub total **|**-**|**-**|**-**|**-**|**-**|



|**A4 Asset and investment**|||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|**purchases, (see table)**|||||||||||||
|||**-**||**-**||**-**||**-**|||||
|||**-**||**-**||**-**||**-**|||||
|**Sub total **||**-**||**-**||**-**||**-**|||**-**||
||||||||||||||
|**Total payments **||**-**||**-**||**-**||**-**|||**-**||
||||||||||||||
|**Net of receipts/(payments)**||**#NAME?**||**-**||**-**||**#NAME?**||**-**|||
|**A5 Transfers between funds**||**-**||**-**||**-**||**-**||**-**|||
|**A6 Cash funds last year end**||**-**||**-**||**-**||**-**||**-**|||
|**Cash funds this year end**||**#NAME?**||**-**||**-**||**#NAME?**||**-**|||





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

|**Categories**<br>**B1 Cash funds**<br>**B2 Other monetary assets**<br>**B3 Investment assets**<br>**B5 Liabilities**<br>**B4 Assets retained for the**<br>**charity’s own use**|**Details**<br>**Details**<br>**Details**<br>**Details**<br>**Details**<br>**Total cash funds**<br>(agree balances with receipts and payments<br>account(s))|**to nearest £**<br>**-**<br>**-**<br>**-**<br>**-**<br>#NAME?<br>**to nearest £**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**Unrestricted**<br>**funds**<br>**Unrestricted**<br>**funds**<br>**Fund to which**<br>**asset belongs**<br>**Fund to which**<br>**asset belongs**<br>**Fund to which**<br>**liability relates**|**to nearest £**<br>**-**<br>**-**<br>**-**<br>**-**<br>OK<br>**to nearest £**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**Cost (optional)**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**Cost (optional)**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**-**<br>**Restricted**<br>**funds**<br>**Restricted**<br>**funds**<br>**Amount due**<br>**(optional)**|**to nearest £**<br>**Endowment**<br>**funds**|
|---|---|---|---|---|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||OK|
|||||**to nearest £**<br>**Endowment**<br>**funds**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**Current value**<br>**(optional)**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**Current value**<br>**(optional)**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**-**|
|||||**When due**<br>**(optional)**|
||||**-**||
||||**-**||
||||**-**||
||||**-**||
||||**-**||



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

Signature 

Date of Print Name approval 

