ASSETS OF COMMUNITY VALUE

NOMINATION FORM

Section A: About the asset to be nominated
Type of asset: / (e.g. pub, local shop, hospital)
Name of the asset:
Address of the asset:
Postcode:
Asset owners name:
Address:
Postcode
Current occupiers name:
Current occupiers address:
Section B: About your organisation
Name of your organisation:
Address of your organisations:
Postcode:
First name: / Surname:
Position in organisation:
Email address:
Telephone: / Mobile:
Section C: What is your organisation? (please put an X in the relevant box)
/ Constituted Community/Voluntary Group / / Parish/Town Council
/ Neighbourhood Forum / / Community Interest Company
/ Company Limited by Guarantee / / Charity
/ Industrial & Provident Society
How many members do you have (this is particularly important for constituted community groups)?

Please note any information entered in section D may be copied and passed onto the owner of the property you are nominating.

Section D: Supporting information for the nomination
Why do you feel the property/land is an asset of community value? Please provide as much information as possible to demonstrate the following criteria:
  1. Does it currently further the social wellbeing or social interests* of the local community, or has it done so in the recent past? If so, how?
  1. Could it in future further the social wellbeing or social interests* of the local community? If so, how? (This could be different from its current or past use.)
*These could be cultural, recreational and/or sporting interests, so please say which one(s) apply.
Section E: Boundary of the asset
Please either includes a site plan indicating the boundary of the property/land or a sketch plan of the land below (please note the location will be displayed on the website).
We would like to see the following:
The boundaries of the land that you are nominating
The approximate size and position of any buildings on the land
Any roads bordering the site.
Section F: Attachment checklist
/ Copy of the group’s constitution (if you are a constituted group)
/ Name and home addresses of 21 members registered to vote in nominated area (if the group is not constituted)
/ Site boundary plan
Section G: Declaration
I confirm that I have the authority to submit this nomination on behalf of the relevant body and that to the best of my knowledge the information contained in the application is complete and accurate.
Signed
Position in the organisation
Dated (DD/MM/YYYY)

Where to send this form

You can submit this nomination:-

  • By postto: Community Focus Team,North West Leicestershire District Council, Council Offices, Coalville, Leicestershire, LE67 3FJor
  • By email to:

Asset of Community Value – Nomination Form 1 | Page