Contribution Funds for Non-governmental Organizations - a Handbook

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APPENDIX C: PA-5 FORM

File Number:

DEPARTMENT OF JUSTICE CANADA

Contributions to:

REVIEW ENGAGEMENT REPORT

I have reviewed the (Name of Recipient) compliance with the terms and conditions of the Contribution Agreement signed (Date) for the period from to (Period). My review was made in accordance with Canadian generally accepted standards for review engagements and, accordingly, consisted primarily of inquiry, analytical procedures and discussion related to information supplied to me by the recipient.

A review does not constitute an audit and, consequently, I do not express an audit opinion on this matter.

Based on my review, nothing has come to my attention that would cause concern towards the attached itemized Statement of Revenues and Expenditures (PA-1); hence, this Statement of Revenues and Expenditures (PA-1) presents fairly, in all material respect, the revenues received and the expenditures incurred by the Recipient, in accordance with the purpose of the contribution stated in the Contribution Agreement referred to above.

Please respond to the following questions:

1. Was the claim adjusted for the GST/HST rebate?
   • YES
   • NO
2. Do you agree with the amounts stated on the Statement of Revenues and Expenditures (PA-1)?
   • YES
   • NO
3. Do you have supporting sampled documents to validate the amounts claimed?
   • YES
   • NO
4. When completing the Statement of Revenues and expenditures (PA-1) and this form (PA-5), did you compare them with the budget approved in the Agreement?
   • YES
   • NO
5. If required as per the agreement, please provide any explanations given for any variances on the statement of Revenues and Expenditures (PA-1) that exceed the % noted in the Agreement for reallocating budget items?
   • YES
   • NO
   • N/A
6. Did you come across any problems when filling out the Statement of Revenues and Expenditures (PA-1) and this form (PA-5)?
   • YES
   • NO

Note: If you responded NO to questions 1 to 5 or YES to question 6, please provide an explanation:

 

• Print Name:
• Telephone No:
• Signed by:
• Date:
• Title:(Certified Accountant (CGA, CMA, CA) or (Director of Finance *)
• Accounting Firm:

* Only Applicable to Provincial / Territorial Governments or University Establishments

PA-5 (rev. 10/2010)

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