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SayPro Income Source Declaration Form
SayPro Income Source Declaration Form
Form Code: SCLMR-1/ISDF
Reporting Period: [Month & Year]
Submitted By: [Full Name]
Position/Department: [Job Title / Program Name]
Date of Submission: [DD/MM/YYYY]
Contact Email: [Email Address]
Phone Number: [Phone]
🧾 Section A: Income Source Details
| Field | Information (To Be Completed by Declarant) |
|---|---|
| Income Source Name | [e.g., USAID Grant, Training Workshop Fee] |
| Type of Income | ☐ Grant ☐ Training/Consultation ☐ Product Sales ☐ Event Income ☐ Government Contract ☐ Partnership Contribution ☐ Other: _______ |
| Description of Source | [Brief description of income source and purpose] |
| Total Amount Received (ZAR/USD) | [e.g., ZAR 45,000] |
| Date of Receipt | [DD/MM/YYYY] |
| Frequency | ☐ One-time ☐ Monthly ☐ Quarterly ☐ Annual |
| Responsible Person/Entity | [Name of partner, donor, or client] |
| Contract/Agreement Attached? | ☐ Yes ☐ No |
| Supporting Documentation Provided? | ☐ Invoice ☐ Receipt ☐ Transfer Proof ☐ Agreement ☐ Other: _______ |
📦 Section B: Program or Department Allocation
| Program/Department Name | % Allocation | Purpose/Activity Funded |
|---|---|---|
| [e.g., Skills Development] | [XX%] | [e.g., Youth training sessions in Gauteng] |
📈 Section C: Financial Coding (For Finance Office Use Only)
| Financial Code | Description |
|---|---|
| Revenue Category Code | [To be completed by Finance] |
| Project Code | |
| GL Account Reference | |
| Internal Reference Number |
📄 Section D: Declarations
I declare that the information provided above is accurate and that the income reported has been received in line with SayPro’s income policies and procedures.
Name: _________________________
Signature: ______________________
Date: _________________________
🔍 Section E: Finance Department Review
| Reviewed By | Signature | Date | Remarks/Notes |
|---|---|---|---|
| Finance Officer | |||
| Monitoring & Evaluation | |||
| CFO/Executive Approval |
📌 Submission Instructions:
- Submit this form by the 5th of each month to: finance@saypro.org
- Attach all supporting documents as required
- Contact the SayPro Finance Office for queries
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