【正文】 e claim to the appropriate United Kingdom representative. Section (4) (Project expenditure) 1. Value of local cost expenditure to date on the project: GBP 86, 2. Deduct local cost expenditure provided by other anizations: GBP 5, 3. Deduct local cost expenditure not eligible for reimbursement GBP 0 4. Deduct any local costs expenditure already claimed: GBP 80,000 5. Claim now due for reimbursement: GBP1, 6 Section (5) (This claim expenditure details) Attach details of how the sum claimed in Section (4) was used . work carried out, material purchased, labor used, machinery or equipment hired or bought, contracts entered into, and services used etc. Section (6) (Certification) Certification for Claim and request for reimbursement I certify that this claim for GBP1, reimbursement is correct and that the sum requested is properly due on the basis of the information provided above and on the work carried out, material bought in, and other expenses necessarily incurred in connection with the Project. I have the authority to sign this on behalf of the Government of the People’s Republic of China. Signature: …………………….. Name: …………………………. Date: May 30, 20xx Section (7) (for DFID authorized signatory) I have examined this claim and satisfied myself that the information requested in all sections has been provided, and that the claim plies with terms of the Exchange of Notes. I have the authority to sign this on behalf of the Government of United Kingdom. The claim for reimbursement is approved. Signature: ……………………… Name: ……………………………. Date: 7 Form 2： STATEMENT OF EXPENDITURE Project Title::UK/PRC Water Resources Demand Management Assistance ProjectWRDMAP Date: May 30,20xx DFID MIS Code： MIS XXXXXXXXX Claim Number:20xx0502 1 2 3 4 5 6 7 8=5/7 Item No. Budget Line of Project Annual Budget Code Activity Name and Address of Supplier/Consultant Currency and Total Amount of Contract/Budget Amount Eligible for Financing Cumulative Amount Paid to Date GBP Equivalent Amount Charged to Special Account Exchange Rate RMB/GPB 1 Providing consulting advices on financial management on fund uses ￥ 6, ￥ 6, ￥ 6, ￡ 2 Wuwei WR Bureau applies and enforces water demand management tools Wuwei WR Bureau ￥ 100, ￥ 15, ￥ 50, ￡ 1, Total ￡ 106, ￡ 21, ￡ 56, ￡ 1, 14,5727 Supporting Document for this SOE retained at each PMO or CSO respectively Authorized by: Li Ge (Authorized Signature) (注：該表格用于中央項(xiàng)目管理辦公室向英國(guó)國(guó)際發(fā)展部申請(qǐng)資金回補(bǔ)所用 ) 8 Form 3： Special Account Reconciliation Statement Project Title: China Water Resources Demand Management Assistance ProjectWRDMAP MIS XXX Bank Account Number Operating Bank Amount advanced by DFID ￡ 100, Less total amount recovered by DFID ￡ EQUALS PRESENT OUTSTANDING AMOUNT ADVANCED TO THE SPECIAL AMOUNT ￡ 100, Amount in special account at May 30,20xx per bank statement (copy attached) ￡ 18, Plus amount of eligible expenditure documented in attached claim () ￡ 1, Plus amount claimed in previous applications not yet credited at date of bank statement Claim No. Amount 20xx0501 ￡ 80, Subtotal of previous claim(s) not yet credited ￡ 80, Plus bank service charge ￡ Less interest earned credited to the account ￡ EQUALS TOTAL ADVANCE ACOUNTED FOR ￡ 100, DATE： MAY 30, 20xx SIGNATURE: Wang Fengshan TITLE: Project Director Explanation of any discrepancy between totals appearing on line 3 and 9 above (None) 9 FORM 4： Bank Statement (由銀行提供 ) 10 (注：該表格用于中央項(xiàng)目管理辦公室向外匯專(zhuān)用賬戶(hù)申請(qǐng)資金報(bào)賬所用 ) 費(fèi)用報(bào)表 STATEMENT OF EXPENDITURE 項(xiàng)目名稱(chēng)：中英合作水資源需求管理項(xiàng)目 日期： 20xx 年 5 月 30 日 Project Title::UK/PRC Water Resources Demand Management Assistance ProjectWRDMAP Date: May 30,20xx 英國(guó)國(guó)際發(fā)展部系統(tǒng)編號(hào)： MIS XXXXXXXXX 回補(bǔ)申請(qǐng)書(shū)編號(hào)： 20xx0502 DFID MIS Code： MIS XXXXXXXXX Claim Number:20xx0502 1 2 3 4 5 6 7 8=5/7 序號(hào) Item No. 項(xiàng)目預(yù)算編號(hào) Budget Line of Project 年度預(yù)算編號(hào) Annual Budget Code 項(xiàng)目活動(dòng) Activity 供貨商 /咨詢(xún)專(zhuān)家名稱(chēng) Name and Address