ࡱ > I L H 0 , bjbj 4> , 4 ' o h $ y Z ) 6 6 6 . 6 6 6 6 P 6 ? 0 o 6 : 6 6 6 6 o : GRANT CLAIM FORM
PLEASE COMPLETE AND RETURN (together with supporting documentation), preferably by email, to:
HYPERLINK "mailto:grantholder@thepilgrimtrust.org.uk" grantholder@thepilgrimtrust.org.uk or to Clutha House, 10 Storeys Gate, London SW1P 3AY
Payment of a grant is triggered by the production of appropriate evidence of expenditure in connection with the project. This claim form must be accompanied by evidence of expenditure. If your project is being paid in instalments and you are claiming the second or subsequent instalments, the claim should also be accompanied by a brief report of around 2 pages outlining how the project is proceeding. Failure to claim the grant within six months of the instalment becoming due will result in the offer of funds being withdrawn. A full report on the achievements that have resulted from the grant will be due at the end of the funding period.
Grantholder DetailsOrganisation Name Grant Reference NoProject NameGrantee Address
Project Expenditure Details
Detail of cost (e.g. professional fees, employment cost etc.)Total claimed to date (if claims have been made prior to this one)Amount that is the subject of this claim
Declaration
I certify that, to the best of my knowledge and belief, the information is accurate, the expenditure has been properly incurred, that any income generated by the project has been declared and that no other grant has or will be claimed from the Pilgrim Trust or from any other source towards these costs.
Signed (leave blank if emailing)
DateName (BLOCK LETTERS)
Position in the Institution/Organisation
I CONFIRM THAT MY BANK DETAILS HAVE NOT CHANGED
Official Use OnlyApproved By:
Date:
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