<p>Report on Expenditure of Funds</p><p>Name, Address (Beneficiary): ID ______PN ______</p><p>Project Name:</p><p>Type / Amount of Funding: Decision Dated:</p><p> Grant EUR  Matching Donation EUR  Matching Loan EUR</p><p>1. FACTUAL REPORT (Description of the measures carried out, deviations from planned budget and costs, unforeseen events, goals achieved, etc. Please use a separate sheet if necessary.) </p><p>Page 1 of 3 2011-05 2. FINANCIAL REPORT a) Total Costs</p><p>Estimated Costs EUR Actual Costs EUR</p><p>Total Total</p><p> b) Financing </p><p>Estimated Financing Actual Financing Donors and Own Resources EUR Donors and Own Resources EUR</p><p>SAGST Amount (planned) Amount (actual)</p><p>Please enclose:</p><p>» one copy of the balance sheet and P&L statement for the year(s) you received funding from SAGST » evidence documenting how our funds were recorded in your accounting » one copy of your tax exemption certificate valid for the grant year</p><p>Page 2 of 3 2011-05 3. DECLARATION OF THE BENEFICIARY I hereby declare that » the funds were used according to their intended purpose. » the costs and their financing as listed here reflect the actual accounting figures, and the information provided in the Report on Expenditure of Funds, or in any attachments submitted herewith, is correct. » all project-related documents will be kept for the duration of the retention periods required by commercial law and tax law and will be made available for inspection by the Software AG Foundation upon request.</p><p>Place and date Signature(s), stamp</p><p>4 STATEMENT OF THE TAX CONSULTANT / AUDITOR</p><p>We have examined the Report on Expenditure of Funds. Based on a review of the (accounting) evidence, I attest that the information provided in the Report on Expenditure of Funds agrees with the actual costs and the actual financing.</p><p>Place and date Signature(s), stamp</p><p>In lieu of this declaration, you may submit a copy of a Report on Expenditure of Funds submitted to a government body or to Aktion Mensch. For smaller projects, it is also possible to submit copies of invoices.</p><p>INTERNAL (for use only by the Software AG Foundation)</p><p>Der Verwendungsnachweis wurde anhand der vorliegenden Unterlagen geprüft. Es ergaben sich keine Beanstandungen.</p><p>Ablage erfolgt am:</p><p>Datum Unterschrift Projektleiter</p><p>Datum Unterschrift Projektcontrolling / Revision</p><p>Page 3 of 3 2011-05</p>