Tandridge District Council Forms

Your Business Details

Category of Business

Please choose one of the following options

I am a small business in a shared or flexible workspaceI am a market trader who does not pay business ratesI run my business from home and pay Council TaxI am in none of the above categories

Which period are you applying for the grant for:

5th November to 2nd December 20202nd December to 16th December 2020

Do you pay Business Rates to Tandridge

YesNo

Do you pay Council Tax?

YesNo

To be eligible to receive this Fund, your business must evidence ongoing fixed building-related costs.

You may provide text to support your claim and also attach documents at the bottom of the page. Examples of proof in support of this point may include, but not limited to; a Signed Lease Agreement, Signed Licence Agreement, Signed Rental Agreement or Signed Mortgage Agreement.

If you believe your company is eligible for a Grant, but does not fall into the categories already detailed, please submit your justification underpinning your claim.

You may provide text to support your claim and also attach documents at the bottom of the page.

Please summarise your evidence here

Loss of Income Due to COVID-19

To be eligible to receive this fund, your business must demonstrate that you have suffered a significant fall in income due to the COVID-19 crisis.

This can include evidence of physical business closure, loss of regular business income, reduced sales/activity volumes supported by evidence that the gross amount earned less expenses incurred for the COVID-19 period represent a significant fall in net income.

Examples of proof in support of this point might include, but are not limited to documentation from your Bank, Accountant or Financial Advisers.

Please summarise your evidence here

Number of Employees

An Employee is defined as a person who has received remuneration from your company in the last 6 months (up to October 2020) and who has a full-time or part-time contract to work for your company.

You may provide text to support your evidence and may attach documents at the bottom of the page. Examples of proof in support of this point include, but are not limited to Payroll or Personnel records.

Please summarise your evidence here

Trading Dates

To be eligible to receive this fund, your business must have been trading on or before 4 November 2020.

You may provide text to support your evidence and may attach documents at the bottom of the page. Examples of proof in support of this point include but are not limited to Registration with Companies House, Registration with the Charity Commission or evidence from HRMC.

Please summarise your evidence here

Please attach any supporting documentation here

Applicant Details

First name

Last name

Email

Primary contact telephone number

Contact mobile phone number

Applicant Address

Address

Business Details

Business name

(As registered with Companies House)

Business Address

Address

Business rates account reference (if applicable)

(As registered with Companies House)

Are you a Limited Company?

YesNo

Company number

(As registered with Companies House * If not a Ltd Company straight to Title of Applicant)

VAT registration number

(As registered with HMRC)

Business Sector

Details of businesses subject to restrictions or closure and those able to remain open are available on pages 29 to 32 of the government's regulations.

Please list the services, trades or business products your business provides

Accounts Contact

Bank Details

Bank sort code

Bank account number

Name of bank account holder

Name of bank

Declaration of Compliant Trading

I confirm that within the past five years my organisation or any person who has powers of representation, decision or control in the organisation has not been convicted anywhere in the world of any offences listed in the link below:

YesNo

List_of_Mandatory_and_Discretionary_Exclusions.pdf

I confirm that my organisation is taking all possible steps to ensure the elimination of offences covered by the Modern Slavery Act 2015 from my organisations supply chains.

YesNo

I can confirm that in the last five years, my organisation has not been subject to a formal investigation which resulted in a proven case of 'blacklisting'?

YesNo

Please give details

I can confirm that this award complies with the EU law on Sate Aid on the basis that, including this award, the company making the request shall not receive more than €200,000 in total of de minimis aid within the current financial year or the previous two financial years. See the de minimis Regulations 1407/2013 (as published in the Official Journal of the European Union L352 24.12.2013)

Yes

Consequences of misrepresentation

A serious misrepresentation in supplying this information may have the following consequences for the signatory that made the representation:

* The Council may sue the signatory for damages under the Misrepresentation Act 1967
* If fraud, or fraudulent intent, can be proved, the signatory may be prosecuted and convicted of the offence of fraud by false representation under s.2 of the Fraud Act 2006, which can carry a sentence of up to 10 years or a fine (or both).
* The signatory may be excluded from bidding for Council contracts for three years, under regulation 57(8)(h)(i) of the Public Contract Regulations 2015.

I understand that any business caught falsifying their records to gain grant money will face prosecution and any funding issued will be subject to claw back

Yes

Name

Role in company

Date

COVID-19 Additional Restrictions Grant

Your Business Details

Loss of Income Due to COVID-19

Number of Employees

Trading Dates

Applicant Details

Applicant Address

Business Address

Bank Details

Declaration of Compliant Trading

Consequences of misrepresentation