1.Nameof Asset:

Former Convent/Library at Ashburton Park

2.Your Details:

Full name of your group / organisation
Full name of your group / organisation:
Other names commonly used:
Address:
Post code:
Telephone:
Email address:
Website address:
Main contact
Full name:
Position:
Address:
Post code:
Email address
Daytime telephone number:
Evening telephone number:

3.What type of organisation / group are you?

Type / Please tick (√) / Type / Please tick (√)
Partnership / Constituted Group
Company Limited by Guarantee / Newly formed group for asset transfer
Charity (what is the charity number?) 1146703 / Voluntary Organisation
Community Interest Company / Friendly Society
Public Sector / Co-operative society
Industrial and provident society / Unincorporated association
Unincorporated social enterprise / Other [please state]

4.What year was your group / organisation formed?

5.What skills do your group / organisation have?

Skills / YES / NO / If ‘YES’, please give brief details
Management
Financial Management
Marketing / .
Community Knowledge
Partnership Working
Managing assets
Human Resources
Business Planning
Legal
Fund Raising

6.What resources do your group / organisation have access to?

Resources / YES / NO / If ‘YES’, please give brief details
Financial [own]
Financial [Grant sources]
Marketing
People
Time
Capital
Revenue

7.What support do you feel that you might need to develop plans to manage the asset, this maybe to subcontract part of the building, a grant or a loan?

8.Have you taken external advice from anyone else? (Please tell us more)

Part 2: Please tell us more about your organisation

9.Funding (please give details of any successful funding you have applied for and obtainedin the last three years)

10.Financesdoes your organisation have a bank account in the organisations name which needs two signatories?

Yes No

11.Committee Meetings

Do you have a management committee or board of trustees which meets regularly?
Yes No
If so, how often does it meet?
When was your last annual general meeting?

12.Staff and volunteers

Does your organisation employ staff? Yes No
Does your organisation use volunteers? Yes No

13.Insurance(this relates to what you do at the moment. If you manage land or buildings you may need additional insurance in order to manage the former Convent/Library.

Do you have enough insurance cover?
Public Liability insurance (£10 million minimum)
Yes No
Employer’s liability cover (if you employ staff) (£10 million minimum)
Yes No Not applicable
Professional indemnity (if you give advice to members of the public) (£2 million minimum)
Yes No Not applicable
Property and equipment insurance against fire, theft, loss or damage
Yes No Not applicable
Vehicle/driver insurance (if you own or drive vehicles)
Yes No Not applicable

14.WHERE DO YOU CURRENTLY PROVIDE YOUR SERVICES?

15. Data Protection Act

We may use information on this form for purposes which are registered under the terms of the Data Protection Act 1984.
Occasionally, we receive requests from agencies that we work with, to pass on contact details of the organisations we support. We would normally only give out published office addresses, as this information is already in the public domain. If you do not want us to give out this information, please tick the following box.
I do not wish my organization’s contact details to be passed on to any other agencies.
We do not pass on, sell, or otherwise give out this information to commercial organisations.

16.SIGNATURE

Name (print): (Sign)
Position in organisation:
Date:

Please email completed form along with your business planand supporting documents to following email address by midday on Friday 11 November 2016:

Nigel Evans
Partner
Stiles Harold Williams
Email: