Príloha č.3 6b

Declaration concerning the financial data of Programme SR… after expiry date (mention date e.g. ….)

The bank accounts of the programme SR …… are following: 
-	 the account of the National Fund 
-	 the account with the dispositional right of the CFCU 

Following the provisions of Article 4 § 4 of the Memorandum of Understanding on the establishment of the National Fund, the undersigned Vladimír Tvaroška, NAO of the Programme SR …. hereby declares that:

1.	all projects implemented under Programme SR …… have been completed and all payments made.

2.	the total eligible expenditure amounts to (all figures in €) (1)

1. Total value of Contracts signed
     Phare contribution
     National contribution (co-financing)	
	
2. Total value of Payments made
     Phare contribution
     National contribution (co-financing)	                                
 	
3. Total value of Savings made on contracts
     Phare contribution
     National contribution (co-financing)	

4. Final Cost of Programme SR ….
     Phare contribution
     National contribution (co-financing)	(1-3=4=2)

3.	all non-used funds have been recovered from the CFCU on behalf of the NF (in line with Article 3 (viii) of the MoU)

4.	-  the bank account SR…../CFCU on ………….. is in the amount of ……….. EUR
       -  the bank account SR………/NF on …………. is in the amount of ……….. EUR
	Annex: Bank statements of CFCU and NF and the corresponding Perseus bank reconciliations.

5.	All Perseus data including co-financing contribution has been updated and all contracts have  been closed.
     
6.	The following amounts are withheld in the bank accounts as retention money (see table N°1 attached)

7.	The following sub-programmes-projects-contracts have been audited: (see table N°2 attached)

8.	This statement represents a true and a fair view of the financial situation of the programme at the date of signature

    (1) Please enclose a similar table by sub-programme and by project

 Date of submission	____________	(at the latest 2 months after the end of the disbursement period of the programme)

Prepared by	____________________	_______
	Signature	Date

National Authorising Officer	____________________	_______
	Signature	Date

Table N°1 Information concerning retention money under programme (SR …….):

	Name of IA	Bank account	Amount EUR	Expiry date	

					

Table N°2 Information concerning audits carried out under programme (SR …….):

	No fraud or irregularities found	Financial Findings
in amounts of EUR	Comments	

				

Please attach a narrative summary of the financial findings if applicable.