Asset Transfer Stage 2 Main Application Form

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Homer Powers
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1 Asset Transfer Stage 2 Main Application Form If you want to apply for an Asset Transfer, you will need to fill in this application form. Please read the accompanying guidance notes while you are filling in this form. We will not be able to process your application unless we receive all the information that is relevant to your asset transfer. You should fill in all the sections of the form and write 'not applicable' if a section does not apply to you. Please write clearly in BLOCK CAPITALS and use black ink. An e- version of this application form is available on Coventry City Council's website. Data Protection Act 1998 PLEASE READ CAREFULLY The details you provide on this form will only be used in connection with assessing your organisations application for Asset Transfer. Your information may be shared with Elected Members, colleagues within Coventry City Council and other Voluntary and Community agencies such as Voluntary Action Coventry and Coventry & Warwickshire Co-operative Development Agency. SECTION A ABOUT YOU AND YOUR ORGANISATION 1 Please provide the details of the organisation making the application Community Asset Transfer reference number. Name of Organisation: Address of Organisation (inc postcode): Tel : 2 Please provide details of the contact person in relation to this application Full Name: Position in Organisation:. Tel : 1

We will not be able to process your application unless we receive all the information that is relevant to your asset transfer.

2 3 What is the legal status of the lead organisation? Registered Charity Charity Registration Number: Registered Charity With Trading Arm Company Limited By Guarantee Charitable Incorporated Organisation (From Spring 2010) Limited Company Company Registration Number: Social Enterprise Unincorporated Company Trust Co-Operative If other please give details: Unregistered Organisation With Formal Rules Voluntary/Community Group Community Interest Company Other (Please Specify) 4 Is the organisation part of a bigger local or national organisation? If yes please provide details 5 What are the current services provided by the organisation? 6 When was the organisation established? 7 Does the organisation have a Business Plan or equivalent document? Name of document: 2

Registration Number: Social Enterprise Unincorporated Company Trust Co-Operative If other please give details: Unregistered Organisation With Formal Rules Voluntary/Community Group Community

3 8 What is the length of time you are requesting the Asset to be transferred for? 1 7 years NB: we would not consider this to be an Asset Transfer but can support you to apply for a shorter term lease or licence if required) 7-21 years Over 21 years Other Please explain: 9 Does the organisation currently manage / or have they previously managed any buildings and/or facilities? please give details If yes give details: 10 Is this a joint or partnership application? If yes, please give details If yes give details of all partners involved: 3

required) 7-21 years Over 21 years Other Please explain: 9 Does the organisation currently manage / or have they previously managed any

4 11 Does your organisation's governing body endorse this application for Asset Transfer? Please tick as appropriate. If you answer no please explain reason(s) why If please explain reason(s) SECTION B GOVERNANCE ARRANGEMENTS OF THE ORGANISATION 12 What are the aims and objectives of the organisation? 13 Does the organisation have a set of governing documents? If please tick as appropriate and also give details on how often they are reviewed and date last reviewed. a b If you have ticked above, please advise on name of the governing document, how often reviewed and when it was last reviewed: Constitution Articles Other (please give details).. Frequency of review: Date last reviewed: 4

organisation? 13 Does the organisation have a set of governing documents?

5 14 Does the organisation have an established Management Committee or Board of Trustees/Directors? If yes, please tick the type of governing body your organisation has and explain how many people there are on it. Management Committee Board of Trustees Board of Directors Other please state: Number of people on the Governing Body: 15 How often does the Governing Body meet? 15a Are minutes of meetings taken? 15b Are signed copies of minutes available? SECTION C EQUAL OPPORTUNITIES AND OTHER POLICIES 16 What policies does the organisation have and when were they last reviewed? Equal Opportunities Health & Safety Volunteers Other (please state):. Other (please state):. Date last reviewed.. Date last reviewed.. Date last reviewed.. Date last reviewed.. Date last reviewed.. 5

Management Committee Board of Trustees Board of Directors Other please state: Number of people on the Governing Body: 15 How often does the Governing Body meet? 15a Are minutes of meetings taken?

6 SECTION D - FINANCIAL SUSTAINABILITY OF THE ORGANISATION 17 What is the annual income of the organisation? Please tick Less than 10,000 10,000 to 30,000 30,000 to 50,000 50,000 to 100,000 Over 100,000 Other (please state) 18 What is the annual expenditure of the organisation? Please tick Less than 10,000 10,000 to 30,000 30,000 to 50,000 50,000 to 100,000 Over 100,000 Other (please state) 19 How is the income generated? Room Hire Fund Raising Trading Membership Fees External Grant Funding Contracts/commissioning Other (please specify) 20 Does the organisation have a bank account in the name of the organisation? 21 Do you need at least two signatories to carry out transactions? 6

Please tick Less than 10,000 10,000 to 30,000 30,000 to 50,000 50,000 to 100,000 Over 100,000 Other (please state) 19 How is the income generated?

7 22 Are any of the signatories on the bank account related? 23 Does the organisation have independently audited accounts? 24 Are the accounts audited and /or externally examined? Audited Externally Examined SECTION E REFEREES Please provide details of 2 Independent Referees who know your organisation. Referee 1 Full Name: Address: Occupation: Tel : Fax : address: Capacity in which known:. Length of time known:.. 7

24 Are the accounts audited and /or externally examined?

8 Referee 2 Full Name: Address: Occupation: Tel : Fax : address: Capacity in which known:. Length of time known:.. SECTION F - DECLARATION Declarer 1 I declare that I have read and accept the guidance notes. As far as I know the information on this application is accurate and truthful. If any information should change, I will notify the Asset Transfer Team immediately in writing. Signed:.. Dated:.. Full Name: Position in Organisation:. Tel : Fax : address: 8

9 Declarer 2 I declare that I have read and accept the guidance notes. As far as I know the information on this application is accurate and truthful. If any information should change, I will notify the Asset Transfer Team immediately in writing. Signed:.. Dated:.. Full Name: Position in Organisation:. Tel : Fax : address: To Be Completed By Receiving Officer: Date Application Received by Coventry City Council: 9

If any information should change, I will notify the Asset Transfer Team immediately in writing. Signed:.

10 SECTION G IMPORTANT NOTES w that you have completed your application, please check that all sections have been completed in accordance with the guidance notes. We recommend that you retain a copy for your records and should your circumstances or contact details change then please notify the appropriate officer. Please DO NOT send any supporting documents with this application, however they may be requested in the future. Applications will be accepted via post or electronically (but will need to be signed before proceeding, once accepted) Please send your completed application form to the following address: Alternatively, it to Asset Transfer Main Application Form Community Development Service People Directorate Floor 6, Civic Centre 4 Coventry CV1 2PY communitydevelopment@coventry.gov.uk Please clearly mark your "Asset Transfer Main Application Form" We will acknowledge your application within 10 working days of receipt 10

Please DO NOT send any supporting documents with this application, however they may be requested in the future.

Mental Health Learning Disabilities Other Older People No Preference Office. Yes. Yes

Mental Health Learning Disabilities Other Older People No Preference Office. Yes. Yes Application Form To be completed in typed form or in your own handwriting in black ink Please refer carefully to the job description and person specification. If the space provided is insufficient please