Business Rates Department, 1 st Floor Colonnades House, Duke Street, Doncaster, South Yorkshire, DN1 1ER, Helpline option 2

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1 Business Rates Department, 1 st Floor Colonnades House, Duke Street, Doncaster, South Yorkshire, DN1 1ER, Helpline option 2 Request for Information Date of Issue The Council has numerous powers to recover outstanding Business Rates. In order to decide the most suitable method to clear the account I require detailed information about your current circumstances and your ability to pay. You are not required by law to give this information but it will help me to see how much you can reasonably afford to pay to clear your Business Rates account. Failure to agree and maintain a suitable payment arrangement will result in Enforcement Agents being instructed to visit your property in order to seize goods to the value of the debt outstanding. Please complete all information clearly. If you need help completing this form please contact the Business Rates department on the number shown above. PART 1 ABOUT YOU First Name Title Mr,Mrs,Miss,Ms Is your business currently trading If not, on what date did your business close? / / Y / N Surname Business Address to which the account relates National Insurance Number Business Rates account number Balance Outstanding Current Home Address Contact Telephone number - Landline Mobile Address

2 Details of previous/ current Business Partnership Please provide the full name of any business partner who was, or is currently trading with you at the time that this debt occurred. Name Current Business Partner Y / N Current Home Address Contact Telephone number (if known) PART 2 ABOUT YOUR HOUSEHOLD The information that you include here should be about yourself, any partners or spouses and children living with you. If you have a son or daughter aged 18 or over they should be included as an adult. If you live with family or are lodging you should only apply this information to yourself and your dependants. The number of vehicles for essential use should only apply to you and your partner or spouse. Adults (18+) Children under 14 Children over 14 Number of vehicles for essential use Please tick Family household Lodger living with Parents Shared Rental PART 3 INCOME Please list all sources of income for yourself. Please note Net Earnings are Gross Earnings less Income Tax, National Insurance Contributions, and deductions under any pension scheme. Type of income Amount Frequency - week/month/annual Net Earnings - Self Employment Net Earnings Paid Employment Job seekers Allowance Employment Support Allowance Pension Credit Child Benefit Tax Credits Maintenance Pension Rent from other properties Contributions from other members of household (e.g. board) Income from Investments Other (please state)

3 PART 4 EXPENDITURE The items in table A are classed as the debts that you should deal with first. This is because the consequences of not paying these debts can be more serious than for others. For example if you do not pay your mortgage you could lose your home. These are known as Priority Debts. Before we look at how much you have available to pay against your Business Rates arrears, we will allow deductions from your income for these items first as well as amounts for other things such as food. Debts (A) Miscellaneous Mortgage Usual monthly payment Additional Arrears Monthly arrears payment Total Balance Outstanding Rent Business Rates (current years instalments if applicable) Council Tax (current year instalments if applicable) Gas Electricity Water Magistrates Court Fines HP essential goods only* Secured Loans Child Maintenance Benefit overpayments Attachment from Earnings (please state who the amounts are being collected by) Child care costs if needed to be able to work (please state number of days care and number of children below) Number of children placed in paid day care Total number of days per month * Where items are being purchased via HP please state what these items are and why they are essential

4 Debts (B) Housekeeping Housekeeping Other (please explain) *Housekeeping is a total monthly figure and should include anything you spend on food, milk, cleaning and toiletry products, clothing and footwear, laundry, nappies and baby items. Anything in addition to these items should be stated separately in other. Debts (C) Essential Travel costs only Public transport costs Petrol Car insurance Car Tax MOT Car maintenance Parking or tolls Breakdown or recovery Other (please state) I declare that the items of expenditure in (C) are essential in order to maintain current employment Signed Debts (D) Telephone Landline Mobiles Debts (E) Other Regular prescription costs Regular dental costs School Meals Other school expenses (please state) Household insurance TV Licence

5 PART 5 OTHER DEBTS You may have other debts from those listed above, such as credit card payments or monthly payments for catalogues or Sky TV. All debts are important but Doncaster Council must consider everything else before these. These are known as non priority debts. This is because the action taken to recover these types of debts is different. For example you may not lose your home or go to prison but you can still be taken to court and ordered to pay. Bailiffs may be used to seize your goods if you still don t pay. If you feel any of these debts should be considered as part of your overall payment plan please state why. Whilst Doncaster Council does not have to take such payments into account all reasonable requests will be considered. Other Debts Unsecured loans Life insurance Sky TV Store cards Credit cards Clothing Cigarettes / entertainment Other (please state) Monthly Payment Total Balance Outstanding I would like you to consider these as deductions from my income because: PART 6 YOUR OFFER OF PAYMENT I would like to offer to pay each week/fortnight/month. Please state the date in the month that you would like to pay. PART 7 WHAT HAPPENS NOW Business Rates staff will consider the information you have provided but may need to apply limits to some items of your expenditure if they go over a reasonable amount. They will then look at what you have left and your offer of payment. Your offer will then be considered against the amount that you earn. Once a decision has been made you will be contacted again indicating whether your offer has been accepted. You do not have to provide a telephone number but it can speed this process up and allow staff to discuss your offer with you directly and come to a decision quicker. Landline Number Mobile

6 PART 8 DECLARATION I declare that to the best of my knowledge that the information given on this form is complete and accurate. Signature Date Sharing Your Information This authority is under a duty to protect the public funds it administers and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes. The information that you provide may also be shared if it is necessary for the Council to carry out its legal functions. In addition information can be shared with other organisations such as the Police or HM Revenues and Customs if it is needed to prevent or detect a criminal offence, prosecute or apprehend an offender or to assess or collect any tax or duty. We will not give information about you to anyone else unless you give us your permission or the law allows us to. If you would like any further information about how your details could be used please contact the Business Rates Office on , option 2.

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