Form FCERM 5: Final statement of account
Final statement of account
Risk management authority (RMA)
Please read through this form and write
clearly in the spaces provided.
Send this form to our grant administration team within two
years of the work on your project being substantially
completed (FCERM8). Fill in the form as soon possible.
You can send us this form before all land and
compensation issues are resolved.


You are responsible for making sure that actual costs
of the estimates in part C are consistent with the final
approved amount, including all the approved
variations.
You should include all completed land-purchase issues
and identify any outstanding land-purchase and
compensation issues. Once any outstanding land and
compensation matters are resolved, you can fill in and
send form FCERM5A. You must send valuers’
certificates and location plans with this form.

The difference between approved and final sums
should have been approved using an FCERM4. You
should have sent us this for approval during the
project. You should make any final adjustments on an
accompanying FCERM4.
Contents
Part A
Part B
Part C
Part D
Part E
Part F
Part G
Part H
Part I
Part J
Scheme details
Certificate of the authority
Financial statement
Grant received
Land-purchase and compensation details
The Data Protection Act 1998
Certificate of the authority
Declaration
Payments
Contact us
Part A Scheme details
Part A Scheme details, continued
A1 Name of the scheme
A5 Grant rate
A2 Name of your authority
100%
45%
A6 Your authority
A3 Grant approval number
For example LDW ....., CPW ....., IDB .....
(We will have given you this number and you must include it
here.)
A4 National project number (capital investment
programme reference number)
Local authority
Highways Agency
Internal Drainage Board
Water company
Part B Certificate of the authority
I confirm that we have completed the scheme in line
with the project appraisal report and any approved
variations.
Part C Financial statement
All authorities must fill in a financial statement.
Approved
estimates
(£)
(a)
Total final
spending
(£)
Breakdown of
final spending
(£)
Preliminary investigations
Specific to the scheme
Preliminary studies
(b)
Construction work (fill in as appropriate)




Authority's own or hired labour
Authority's own or hired plant
Materials
Work carried out by contract (list contractors)
1
FCERM 5 Version 6, April 2016
page 1 of 5
Form FCERM 5: Final statement of account
Approved
estimates
(£)
Total final
spending
(£)
Breakdown of
final spending
(£)
2
3
(c)
Land-purchase payments (including associated fees)
(please specify in part D)
(d)
Compensation payments (including fees)
(please specify in part D)
(e)
All existing staff costs associated with the project


Design
Authority’s project management staff salaries
(f)
Professionals’ and consultants’ fees
(g)
Contingencies
(h)
Other costs (please specify)



(i)
Total
(j)
Less deductible contributions and Partnership Funding (List)
 Private Contributions
 Public Contributions
 Contributions in Kind
(k)
Less cost increases not approved and project items approved
but not eligible for grant
(please specify)



(l)
Net spending (eligible for grant)
(i)  (j)  (k)
(m)
For Internal Drainage Boards only:
amount after grant funded by loan
Part D Grant received
£
(a)
Allocated grant
Date of letter
(DD/MM/YYYY)
(b)
Approved variation orders (FCERM4)
Sent to and approved by Environment Agency
Variation number
(1 to …………)
(c)
Total approved to date (a + b) (not including spending funded by other contributors)
(d)
Does this document have an accompanying
FCERM 4?
(e)
Total approved grant (c + d) (subject to approval of item d)
Yes
No
Actual Spend
FCERM 5 Version 6, April 2016
page 2 of 5
Form FCERM 5: Final statement of account
(f)
Total grant due = net spending (l) (eligible for grant) part C x grant rate (in part A)
(g)
Grant received to date
(Note: Depending on audit review) (f – g)
Balance (f – g)
Part E Land-purchase and compensation details
Approved
estimates
(£)
Total final
spending
(£)
Breakdown of
final spending
(£)
Land-purchase payments and associated fees: part C item (c)
Names of vendors, their professional advisors and date payments
settled
1
2
3
4
5
Outstanding land-purchase estimates to be included on form
FCERM5A
Names of vendors, their professional advisors, estimated settlements
and date expected to be settled
1
2
3
4
5
Compensation payments and associated fees: part C item (d)
Names of claimants, their professional advisors and date settled
1
2
3
4
5
Outstanding compensation claims to be included on form FCERM5A,
and expected date of settlement
Names of claimants, their professional advisors, estimated
settlement value and expected settlement date
1
2
3
4
5
FCERM 5 Version 6, April 2016
page 3 of 5
Form FCERM 5: Final statement of account
Part F The Data Protection Act 1998
Part H Declaration, continued
We, the Environment Agency, will process the information you
provide so that we can deal with your application, make sure
you keep to the conditions of the licence, permit or
registration, and process renewals.
We may also process or release the information to:
Name






offer you documents or services relating to environmental
matters;
consult the public, public organisations and other
organisations (for example, the Health and Safety
Executive, local authorities, the emergency services, the
Department for Environment, Food and Rural Affairs) on
environmental issues;
carry out research and development work on
environmental issues;
provide information from the public register to anyone
who asks;
prevent anyone from breaking environmental law,
investigate cases where environmental law may have
been broken, and take any action that is needed;
assess whether customers are satisfied with our service,
and to improve our service; and
respond to requests for information under the Freedom of
Information Act 2000 and the Environmental Information
Regulations 2004 (if the Data Protection Act allows).
Title (Mr, Mrs, Miss, Other)
First name
Last name
Job title
Contact numbers, including the area code
Phone
Fax
Mobile
Email
.
.
Part I Payments
We may pass the information on to our agents or
representatives to do these things for us.
We will pay any balance of the grant funding for this claim to
your authority's bank.
Have your authority’s bank details changed since your last
payment?
Yes
No
Part G Certificate of the authority
Part J Contact us
Your Chief Executive Officer or authorised officer must
fill this part in.
I confirm the following:
All details in this form are correct
We have kept to the conditions set out in the relevant
grant memorandum
We have clearly identified all amounts received and
receivable against this project
We have spent the grant properly
For Internal Drainage Boards only: we have used any
loan approved for funding this scheme to meet the cost
of this project only
We have applied for any balance of the grant funding for
this scheme
If you need help filling in this form, please contact the person
who sent you it or contact us as shown below.
If any of your authority’s bank’s details change, please send
details, in a separate letter, to:
Grant Administration Team
Environment Agency
Manley House
Kestrel Way
Sowton
Exeter
EX2 7LQ
The letter should be signed by your authorised Finance
Officer.
Telephone: 02030 252221
Email: [email protected]
Website: https://www.gov.uk/government/collections/floodand-coastal-defence-funding-for-risk-management-authorities

Part H Declaration
Warning
If you make a false or inaccurate statement you may lose
your entitlement to grant funding.
Signature
Please tell us if you need information in a
different language or format (for example, in
large print) so we can keep in touch with you
more easily.
Date (DD/MM/YYYY)
FCERM 5 Version 6, April 2016
page 4 of 5
Form FCERM 5: Final statement of account
For Environment Agency use only
Findings and comments
Action required
Signature
Name
Title (Mr, Mrs, Miss, Other)
Date (DD/MM/YYYY)
First name
Last name
FCERM 5 Version 6, April 2016
page 5 of 5