Local restrictions support grant form | East Hampshire District Council

Please complete this form if you wish to request a payment as part of the local restrictions support grant arrangements.

This forms covers to the following periods:

5 November to 2 December 2020
From 26 December 2020

On completion of this form, your application will be subject to further checks on eligibility and if approved, a single payment will be made for each 28-day period that these national restrictions apply.

Please confirm the period you are applying for? *

If you recieved a payment from the local restrictions support grant (5 November to 2 December), you do not need to reapply for this grant.

Business rates and eligibility details

Please provide the following information from your most recent business rates bill.

Business rates account number

The business name as it appears on your business rates bill *

The billed address (the address is which the business rates bill relates) *

Postcode *

Your rateable value *

Qualifying business activity undertaken at these premises *

Please state your other qualifying business *

How will this funding be used? *

We are asking for this information because we are expected to account for how the grant funding has been spent. Your data will be shared with BEIS (Department for Business, Energy & Industrial Strategy) and they may contact you for research and evaluation purposes.

For remittance and further contact

Payment name *

Payment address *

Postcode *

Email address *

Phone number *

Your VAT number (if applicable)

Company registration number (if applicable)

Your bank account details for payment

Please add your bank account details in the format shown below.

Sort code *

Bank account number *

Payment name *

Declaration

In completing this declaration, I confirm that the information contained in this form is true, complete and correct.

I understand that East Hampshire District Council may verify this information and I declare that I confirm that the applicant business:

is registered as a business ratepayer
was occupying and trading from the business premises on Wednesday 4 November 2020
was providing services within one of the business or service sectors prescribed
was required to and closed the business premises due to national restrictions announced

and that:

the business is not subject to insolvency, striking off or any administration proceedings
the business is not in receipt of state funded support in excess of the de miminis or the current COVID-19 temporary state aid framework
that the business did not fall within the definition of an undertaking in difficulty on 31 December 2019 (excluding small and micro businesses)
the payment details provided are in respect of the official business account of the eligible business

The applicant confirms that any change in circumstance which affects the eligibility to a local restriction support grant will be notified to East Hampshire District Council in order to prevent the payment of support grants for which the business would no longer be entitled.

Any person or business found to have falsified records, given false or misleading information or omitted information to gain grant money, may be considered to have committed a criminal offence and face prosecution.

Any funding provided which is found to have been issued through deliberate manipulation and fraud will be subject to claw back using all legal powers available.

Your name *

Position in company *

I agree to all of the above statements *

Share this page

Email alerts