Page 223 - All SFAC DOC file

Submitted by M/s,Pioneer Holon Agroecology Pvt Ltd

CHECKLIST AND SIGNATURE PAGE

CIP requests that your organization submit several documents along with this completed
questionnaire. Complete this page to ensure that all requested information has been included.

• Complete the checklist:
/ ration Papers or Certificate of Registration is attached.
corpo
Information describing your organization is attached.
Organizational chart, if available, is attached.

Policies and Procedures Manual, if available is attached.
Accounting Policies and Procedures Manual, if available is attached.

A Negotiated Indirect Cost Rate Agreement is attached.
Copy of your organization's most recent audit is attached.
If no recent audit, a "Balance Sheet" and "Revenue and Expense Statement" for the prior fiscal or
✓ ,lendar year.

All questions have been fully answered.
0n
authorized individual has signed and dated this page.

The Accounting Questionnaire must be signed and dated by an authorized person who has either
completed or reviewed the form.

Approved by: Gunanidhi Nayak
Name Signature

Director 22-09-2020
Title Date
Complete the questionnaire and checklist, sign and return it (along with any attachments) to
CIP, You may mail or e-mail the completed questionnaire to your CIP local contact (Country
Finance Specialist / Local Accountant or PMU Specialist).

CIP DUE DILIGENCE QUESTIONNAIRE 10] te

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