Support for Businesses Affected by Flooding Application Form. Introduction FOR OFFICE USE ONLY

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1 FOR OFFICE USE ONLY Receipt stamp/application Reference Number (Canterbury City Council use only) Introduction The Support for Businesses Affected by Flooding Grant is designed to support small and medium sized businesses located in flood affected areas that have been impacted by the floods and suffered a significant loss of trade. We appreciate many of the difficulties caused by the flooding and seek your support in helping us administer the public funding made available to alleviate those difficulties. The Council aims to close the business support scheme to new applications on Friday 25 th July 2014 at 5pm. Please read the guidance notes, complete the application in full and provide the required supporting documents. Failure to supply a fully completed form with signed declaration along with all the required information may invalidate or delay the processing of your application. If you need more space to answer any questions or want to provide additional information go to the end of this form for extra space. If you have any questions about the administration of the grant, please business@canterbury.gov.uk or call our Customer Services Team on Once completed, please return a signed paper copy of this application form to the Support for Businesses Affected by Flooding Grant, Business & Regeneration Division, Canterbury City Council, Military Road, Canterbury, Kent CT1 1YW. Alternatively please scan and a signed copy with supporting documentation to business@canterbury.gov.uk Following submission the Council will assess grant applications within a few days and if approved you will be notified of the decision shortly after. For approved grant applications, payment will be processed and awarded as soon as possible via BACS. Page 1

2 1. Applicant s Name and Address Name of business/organisation requesting grant Address of business premises (to which the claim relates) Postcode Type of business/organisation (sole trader, partnership, limited company, etc.) Business sector (e.g. retail) Name of applicant Title (e.g. Dr, Mr, Mrs, Miss) Surname Forename Role in this business Contact telephone number Page 2

3 Is the above business a small or medium sized enterprise (less than 500 employees). Please note that this scheme is only available to small or medium sized enterprises. Yes No If you answered no, we are unable to progress your application. 2. Business premises Do you own or lease your business premises? Own Lease Other If other, please provide details below. If you are a leaseholder, are you responsible for the fabric of the building or is this the responsibility of your landlord? 3. Impacts Were you directly, or indirectly impacted by the flooding? Please tick the relevant box below. Directly Indirectly How were you affected by the flooding? (e.g. water entered premises from highway, ground water infiltration from below or road closed due to flooding prevented customers visiting premises). Page 3

4 Please describe these impacts (e.g. equipment damage, loss of trade etc) Please state when you were directly flooded or indirectly impacted by the flooding. 4. Funding requested Please fill in one or more of the claim categories listed below for which you would like to claim. If you are able to recover VAT, please exclude VAT from these costs. Claim category Details of damage/impact experienced Amount of grant requested to cover losses not recoverable elsewhere Immediate clear up costs (not covered by insurance) Non recoverable insurance excesses for repair or replacement of equipment and stock Page 4

5 Non recoverable insurance excesses for repair or replacement of building structures Temporary Business Accommodation Extra staff costs Exceptional business costs (e.g. hire of dehumidifiers) Structural surveys Page 5

6 Security Measures Exceptional costs to improve access for suppliers or customers Significant Loss of Trade Grant requested for non-recoverable losses - SUB TOTAL (Except in exceptional cases the maximum grant available is 2,500 please refer to the guidance notes) If you have spent money on other items which you think may be covered by this grant but don t fit the claim categories above, please outline these below. Claim category Details of damage/impact experienced Amount of grant requested to cover losses not recoverable elsewhere Page 6

7 GRANT REQUESTED SUB TOTAL (Except in exceptional cases the maximum grant available is 2,500 please refer to the guidance notes) Total grant requested for non-recoverable losses Page 7

8 5. Supporting documentation Below is a list of the supporting documentation required, which should be sent in with your application, where relevant to the claim. a. Evidence of loss / impact (such as photographs) and evidence that this loss is directly attributable to the recent flooding. b. Details of the insurance cover in place for the business and the terms of the policy including policy number and contact details. Additionally any correspondence with your insurer since the start of the floods with regard to the payment of excesses and claiming for impacts including claim reference numbers. c. For each item for which a grant is requested, evidence is required for the damage or impact indicating the expenditure incurred for every claimed item. This should take the form of one (or more) of the following; A receipt or other evidence of the works undertaken, or a quote for the works you wish to undertake, for which you are claiming; and/or Detailed monthly management accounts (or other trading accounts) to evidence loss of trade for 2013/2014 and 2012/2013 where relevant. 6. Value Added Tax (VAT) declaration. All applicants must complete this declaration. VAT is complex and applicants should not assume that VAT is recoverable even if the business or organisation is registered. Applicants must seek advice from their accountant, a VAT specialist or H M Revenue & Customs, before submitting an application for grant aid. The advice applicants receive should be reported to Canterbury City Council in this application, with specific statements included on how the applicant plans to handle VAT on items listed at Question 4. Canterbury City Council cannot be held responsible for any aspect of VAT or other areas of taxation; it is the applicants responsibility to resolve these issues. Please select one of the following options below and detail the advice given and by whom, as necessary in the text box below. I am/we are registered for VAT and will not be including VAT on grant claims I am/we are not registered for VAT and advice has been taken as outlined in the box below 7. Grant requested in this application. All applicants must complete this section. Please state the total amount of grant you wish to apply for (Figure should be taken from the total grant requested table in Question 4) 8. State aid. All applicants must complete this section. As the Flood Business Support Scheme is a form of state aid, we must know if you have received or are receiving state aid. State aid support to businesses is regulated by the European Union. Support will be state aid compliant Page 8

9 where it is provided in accordance with the De Minimis Regulations (1407/2013). Please see the guidance notes for further details. Please complete and sign the following declaration. Your application will not be considered without this being completed. I confirm that the Flood Relief Support Scheme Grant, which the organisation named in Question 1 is applying for, will not result in the undertaking having received more than then 200,000 Euro (approximately 167,000) of cumulative De Minimis aid in this three year period (consisting of the current financial year and the two previous financial years). I acknowledge that I am authorised to sign on behalf of the business and understand the requirements of the De Minimis (EC Regulations 1407/2013). Printed name Signature 9. Business Bank Account Information We will be making all approved grant payments by BACS. Please provide the following information to enable this. Bank Account Name Account Number Sort code 10. Declaration. All applicants must complete this section. To the best of my knowledge, the information both on this form and all other information given in support of this application are correct. I authorise any enquiries necessary to be made. I understand that if I make a false claim I may be prosecuted. I confirm that I understand the purpose of this form and the reasons for the collection of my/our personal data (to the extent that this form contains information which is personal data for the purposes of the Data Protection Act 1998) and that I agree to my/our personal data being used as stated. Page 9

10 I authorise enquires to be made with my insurance company to clarify any issues or queries about my insurance cover and any claims made. If any of the information changes I will inform Canterbury City Council immediately. The declaration must be signed by one of the owners of the business, or one director in the case of limited companies. Name, Business Name and Address Signature and Date Once completed, the application, signed declaration and supporting documentation should be posted to: Support for Businesses Affected by Flooding Grant, Business & Regeneration Division, Canterbury City Council, Military Road, Canterbury, Kent, CT1 1YW Alternatively, please scan the application, signed declaration and supporting documentation and to business@canterbury.gov.uk SCHEME TO CLOSE: FRIDAY 25TH JULY 2014 AT 5PM You can submit your application at any time up to and including the closing date although we urge you to submit this as early as possible due to the limited funds available. Page 10

11 Additional information Page 11