Common use of Funding Request Clause in Contracts

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER Grant Stream: COMMISSIONER’S GRANT Period From: 1st November 2015 To: 30th April 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 CPG15034 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER BRITISH DEAF ASSOCIATION Grant Stream: COMMISSIONER’S GRANT Period From: 1st November September 2015 To: 30th April 31st August 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 SG15012 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER VOX FEMINARUM Grant Stream: COMMISSIONER’S GRANT Period From: 1st November 2015 May 2016 To: 30th April 31st October 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 SG14027 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER NCHA Grant Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 CPG15017 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER SV2 Grant Stream: COMMISSIONER’S GRANT Period From: 1st November October 2015 To: 30th April 31st March 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 CPG15032 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER Grant TRIDENT REACH THE PEOPLE XXXXXXX Xxxxx Stream: COMMISSIONER’S GRANT Period From: 1st November 2015 May 2016 To: 30th April 31st October 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 SG15010 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER DDVSAS Grant Stream: COMMISSIONER’S GRANT Period From: 1st November October 2015 To: to 30th April September 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 4893 X012 J001 SG15017 J010 CR15003 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER NEXT STEP Grant Stream: COMMISSIONER’S GRANT Period From: 1st November October 2015 To: 30th April 31st March 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three two month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14043 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER Grant XXXX Xxxxx Stream: COMMISSIONER’S GRANT Period From: 1st November March 2015 To: 30th April 2016 June 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14023 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER JET Grant Stream: COMMISSIONER’S GRANT Period From: 1st November March 2015 To: 30th April 2016 31st August 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14045 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER Grant XXXXXXXXX Xxxxx Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 CPG15027 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER SOUTH DERBYSHIRE DISTRICT Grant Stream: COMMISSIONER’S GRANT Period From: 1st November October 2015 To: 30th April September 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14029 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER MULTI-FAITH CENTRE Grant Stream: COMMISSIONER’S GRANT Period From: 1st November March 2015 To: 30th April 2016 31st August 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three four month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 J003 CR14002 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER REFUGE Grant Stream: COMMISSIONER’S GRANT Period From: 1st November February 2015 To: 30th April 2016 September 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 SG14016 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER SOMERLEA PARK COMMUNITY CENTRE Grant Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14013 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER DERBY WOMEN’S CENTRE Grant Stream: COMMISSIONER’S GRANT Period From: 1st November March 2015 To: 30th April 2016 31st August 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14052 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER DISABILITY DIRECT Grant Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 4893 X012 J001 SG15017 J004 CR14010 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER TRIDENT REACH Grant Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 CPG15008 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EAST MIDLANDS CHAMBER RHUBARB FARM CIC Grant Stream: COMMISSIONER’S GRANT Period From: 1st November October 2015 To: 30th April September 2016 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 LG14039 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER DERBYSHIRE ALCOHOL ADVICESERVICE Grant Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 4893 X012 J001 SG15017 J003 CB14003 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER DERBYSHIRE LAW CENTRE Grant Stream: COMMISSIONER’S GRANT Period From: 1st November July 2015 To: 30th April 2016 31st December 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three four month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 J003 CR14004 ANNEX A(ii): PAYMENT REQUEST AND END OF IN YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER NEXT STEP (AGAINST DOMESTIC ABUSE) Grant Stream: COMMISSIONER’S GRANT Period From: 1st November February 2015 To: 30th April 2016 September 2015 (£)

Funding Request. MONITORING INFORMATION REQUIREMENTS Please confirm that a three four month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 SG15017 J003 CR14007 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 2014/15 Grant Recipient: EAST MIDLANDS CHAMBER METROPLITAN SUPPORT TRUST Grant Stream: COMMISSIONER’S GRANT Period From: 1st November February 2015 To: 30th April 2016 September 2015 (£)