Coronavirus - Tier 4 business rates grant form

Information required from ratepayer for grant payment:

Grant payments will be made by BACS. Please provide the following details:

Declaration

Before you can proceed, you must confirm the following:

This award shall comply with the EU law on State Aid on the basis that, including this award, I the applicant shall not receive more than €800,000 in total of aid within any given 3-year period under Section 3.1 of the European Commission’s Temporary Framework for State Aid including the COVID-19 Temporary Framework scheme for the UK. For aid for uncovered fixed costs under Section 3.12 of the Temporary Framework, the maximum level of aid is €3 million.

I declare that as at 19 December 2020 that the applicant's undertaking was not in financial difficulties. (For the avoidance of doubt, businesses that were in administration, are insolvent or where a striking-off notice has been made at the date of the local lockdown are not eligible for funding under this scheme.)

I understand that knowingly providing incorrect information, or knowingly making a false declaration, could lead to a prosecution under the Fraud Act 2006. I claim the grant, and declare that I am authorised to act on behalf of the above named account holder and are entitled to the grant.

This grant is for the ratepayer only, and may be liable for recovery if the recipient was not the ratepayer on the eligible date.

The information provided in this form may be shared with the Department for Business, Energy and Industrial Strategy for monitoring and evaluation purposes only. To find out more about how we use personal information see our  privacy statement.