Filetype Excel XLS | Posted on 09 Aug 2022 | 3 years ago
Authentication
digital resources
171x Filetype XLS File size 0.56 MB Source: moh.gov.jm
Sheet 1: Authorization Sheet
| AUTHORIZATION SHEET | |||||||
| APPLICATION FOR CONTINUOUS FUNDING OF ACCOUNT AFTER INITIAL ADVANCE | |||||||
| NAME OF SUB-RECIPIENT: | |||||||
| Date | |||||||
| REPORTING PERIOD: | |||||||
| APPLICATION NO. | |||||||
| Application Amount in Words | |||||||
| Application amount in JA$ | |||||||
| Account Name | |||||||
| Account Number | |||||||
| Name of Bank | |||||||
| Authorizing Signature: | |||||||
| Name: | |||||||
| Title: | |||||||
| Authorizing Signature: | |||||||
| Name: | |||||||
| Title: | |||||||
| Form B1 | |||||||||||||||||
| ORGANISATION NAME | |||||||||||||||||
| STATEMENT OF EXPENDITURE | |||||||||||||||||
| APPLICATION FOR CONTINUOUS FUNDING OF ACCOUNT AFTER INITIAL ADVANCE | |||||||||||||||||
| Name of Sub-recipient: | |||||||||||||||||
| Reporting Period: | |||||||||||||||||
| Date: | |||||||||||||||||
| Bank Account No.: | |||||||||||||||||
| Application No.: | 1 | ||||||||||||||||
| Ref No. | Payee | Total Contract Amount (J$) | Total Amount Paid in this Application (J$) | Balance to be paid (J$) | Date of Payment appears on bank statement | % Completion of Activity | Category | MOH Workplan Code | SR Workplan Code | Treatment Sites | Point of Services | Prgramme Areas | Site Levels | Beneficiary Population | Cheque status - CL/OS | ||
| TOTAL | $0.00 | $0.00 | |||||||||||||||
| Authorised Signature : | ________________________ | Date: ____________________ | |||||||||||||||
| Authorised Signature: | ________________________ | Date: ____________________ | |||||||||||||||
| Form B2 | |||||||||||||
| ORGANISATION NAME | |||||||||||||
| SUMMARY OF CATEGORIES | |||||||||||||
| APPLICATION FOR CONTINUOUS FUNDING OF ACCOUNT AFTER | |||||||||||||
| INITIAL ADVANCE | |||||||||||||
| Name of Sub-recipient: | |||||||||||||
| Reporting Period: | |||||||||||||
| Date | |||||||||||||
| Bank Account No.: | |||||||||||||
| Application No. | 1 | ||||||||||||
| This form should be used for all applications for continuous funding of the SR GF special Account. The total on Application amount should be the same total on the B2 and B4 forms. | |||||||||||||
| ORGANISATION NAME: | |||||||||||||
| SUMMARY OF CATEGORIES | |||||||||||||
| Category No. | Category Name | Current Amount | Cummulative Amount | ||||||||||
| 1 | Human Resources | J$0.00 | J$0.00 | ||||||||||
| 2 | Training and Planning | J$0.00 | J$0.00 | ||||||||||
| 3 | Infrastructure & Equipment | J$0.00 | J$0.00 | ||||||||||
| 4 | Communication Materials | J$0.00 | J$0.00 | ||||||||||
| 5 | Technical and Management Assistance | J$0.00 | J$0.00 | ||||||||||
| 6 | Planning and Administration | J$0.00 | J$0.00 | ||||||||||
| 7 | Health Products & Health Equipment | J$0.00 | J$0.00 | ||||||||||
| 8 | Living support to clients/target populations | J$0.00 | J$0.00 | ||||||||||
| 9 | Monitoring and Evaluation | J$0.00 | J$0.00 | ||||||||||
| 10 | Overheads | J$0.00 | J$0.00 | ||||||||||
| Total on Application | J$0.00 | J$0.00 | |||||||||||
| Authorised Signature : | ________________________ | ||||||||||||
| Authorised Signature: | ________________________ | Date: ____________________ | |||||||||||
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