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DSWD-SB- PS-F-007 Fund Utilization Report

DSWD public solicitation report form for fund utilization

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DSWD-SB- PS-F-007: Fund Utilization Report

FUND UTILIZATION REPORT
Date: _________________
1.
2.
3.
5.

Name of Person/Corporation/Organization/Association: ___________________________________________________________________
Business Address__________________________________________________________________________________________________
Contact Number/s: ______________ 4. Special Account No. and Depository Bank: _________________________________________
Solicited Funds (pls. use separate sheet if necessary)

Title of the
Activity and
Description

Purposes

Methodologies Date of
Used for
Solicitation
Solicitation
Activities
Activity
Conducted

Area where the
Funds Generated
Solicitation Projected
Actual
Activities
Amount to Solicited
Conducted be Raised
Amount

Beneficiaries of the Solicited Funds
Number and Target Areas Amount Received
Type

Status

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As of July 31, 2014

DSWD-SB- PS-F-007: Fund Utilization Report

6. Expenditures: (pls. use separate sheet if necessary)
Total Amount Solicited Funds:

____Php__________________________

Particulars
Amount
%
A. Program Concerns (The 80% of the total funds to be generated which allocated for the expenses
incurred in the direct or indirect provision of services to the beneficiary including implementation of
relevant programs and services)

Sub-Total
B. Administrative Concerns (The 20% of the total funds to be generated which allocated for the cost
incurred to support the management and operation of the conduct of the solicitation activity. This
include application fee for a solicitation permit, cost of mailings, printing of letters of appeal, and
others)

Sub-Total
Grand Total
Balances of Solicited Funds

__Php______________________

Prepared and Certified Correct by:
________________________________________
(Signature over Printed Name of the Treasurer
& Position Title/Designation)

________________
Date

Approved by:
__________________________________________
(Signature over Printed Name & Position Title/Designation of the Agency Head)

________________
Date

SUBSCRIBE AND SWORN to before me the undersigned Notary Public for and in __________, this ______
day of ____________ at ____________________ by _________________________________ with Community
Tax
Certificate
no.
__________________________
issued
at
____________________
on
____________________________.

NOTARY PUBLIC

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