8/14/2019 Ministry of Health Annual Return of Tax-Deductible Receipts for Institution

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MINISTRY OF HEALTH

ANNUAL RETURN OF TAX-DEDUCTIBLE RECEIPTS FOR INSTITUTION OF A PUBLICCHARACTER (IPC)

To: IPC Section FORM 6Regulatory Compliance DivisionMinistry of Health, HQCollege of Medicine Building16 College RoadSingapore 169854

(i) This form must be signed by the President/Chairman/CEO or Honorary GeneralSecretary of the organisation.

(ii) This form must be submitted to the Ministry within 6 months after the close of theorganisations financial year-end.

(iii) If this is your first submission, please ensure all the funds raised prior to obtaining theIPC status towards this fund is disclosed.

Name Of IPC:

IPC Reg. No:

Name Of Fund/Programme Approvedfor IPC Status

Effective Date Of IPC Status

Approved Tax-Deductible Period:

Duration (In Years):

Information Declared For The Period :

PART I: FINANCIAL INFORMATION EXTRACTED FROM THE AUDITED STATEMENT OFACCOUNTS FOR PERIOD________________TO _________________

TotalA Tax-deductible donations $B Income and donations received from other sources $C Total Income $D Total Expenditure $E Excess/(Deficit) of total income over expenditure (C - D)

Breakdown of total expenditure:

1 - Direct Charitable Expenses $2 - Fund raising expenses $3

- All other operating expenses $

Percentage of expenditure relating to IPC activities over totalincome [(1+2)/C x 100]

%

Percentage of expenditure relating to non-IPC activities over totalincome [(3)/C x 100]

%

Explanation Notes:(i) Charitable expenses refer to expenses incurred to meet the charity's objectives and othercharitable activities (both within and outside Singapore).(ii) Fund raising expenses are expenses incurred in relation to fundraising activities.

(iii) All other operating expenses include expenses incurred for operating and administrativepurposes and are not charitable or fundraising in nature.(iv) Please refer to MOH website for an updated definition of these financial terms.

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PART II: DECLARATION

On behalf of _________________________________________________(Name of IPC), I____________________________ hereby declare that the above information is correct tothe best of my knowledge.

______________________ ______________ ___________ Name of Chairman/President Signature Date

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8/14/2019 Ministry of Health Annual Return of Tax-Deductible Receipts for Institution

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PART III: AUDITORS REPORT RELATED TO TAX-DEDUCTIBLE RECEIPTS

We have examined the Return of Tax-Deductible Receipts amounting to $____________of______________________ (name of IPC) for the period from __________________to_____________ (financial reporting period).

The Management/Trustees of the Fund* is responsible for establishing and maintainingadequate accounting and internal control systems and for ensuring compliance with the ____________________________ (Please insert the prevailing Act and Regulations1

pertaining to the period under review). The Return is the responsibility of theManagement/Trustees of the Fund*. Our responsibility is to express an opinion on theamounts shown in the Statements based on our examination.

Our examination was made in accordance with Singapore Standards on Auditing and,

accordingly, included such tests of the accounting records and such other auditingprocedures as we considered appropriate in the circumstances. We believe that our auditprovides a reasonable basis for our opinion.

In our opinion, the amounts of tax-deductible donations shown on the attached Return of Tax-Deductible Receipts (marked for identification) totalling $_______ are in accordance with thedocuments and records kept by [name of IPC] and have been included in accordance withthe relevant terms and conditions specified by the Ministry of Health.

During the course of our examination, nothing has come to our attention to cause us tobelieve that:

a) Tax-deductible receipts were issued for donations other than outright cash donations;b) Donations for which tax-deductible receipts have been issued were used for activitiesother than those approved by the Regulations;

c) The internal accounting controls over the issue and custody of tax-deductible receiptswere inadequate;

d) There were significant contravention of the Regulations regarding the administrationof tax-deductible receipts;

e) Donations were used in contravention with the objects of the Fund.

Our report is solely for the purpose set forth in the first paragraph of this Auditors ReportRelated to Tax Deductible Receipts and for your information, and is not to be used for anyother parties other than to the Ministry of Health. This report relates only to the itemsspecified in the Return and does not extend to any financial statements of the Fund, takenas a whole.

______________ ___________________ ______________ Name of Auditor (Signature) Date

replace with appropriate terms

1 Charities Act and all the Regulations wef 1 Mar 2007

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