FLOODRECOVERY GRANTApplication Form

This is a one-off grant scheme to help businesses in Lancashire significantly affected by the December 2015floods. Please read the Guidance Notes for Businesses before completing this form.Grants will support individual business working with your local authority liaison officer.For further telephone supportcontact Boost, Lancashire's Business Growth Hub on 0800 488 0057 or

A.Applicant Details
Contact name:
Name of Business:
Address:
Telephone:
Fax:
Email:
Temporary contact details if applicable:
B. Can you apply? We advise that you read the guidance notes attached carefully before answering the following questions. You must be able to tick every question to be eligible to apply
1. Is your business located in Lancaster, Ribble Valley or Wyre?
2. Was your business trading on 5th December 2015?
3. Does your business employ between 0-250 people (full time equivalent)?
4. What type of business are you? (tick one box only)
Sole Trader / Partnership / Limited Company
Company Limited by Guarantee / Co-operative / Other*
* Please specify
VAT No (if applicable) / Company Reg No (if applicable)
5. Which of these sectors below does your business operate in? (tick one box only) Please noterestrictions apply (see Guidance Notes)
Digital & Creative / Energy & Environment / Retail
Manufacturing / Visitor Economy / Financial & ProfessionalServices
Logistics/
Distribution / Health / Other* please specify
6. Was your business flooded (please give details of extent, duration and associated impacts)?
6a. Was your business otherwise severely affected, if so how?Any grant will only be paid in exceptional circumstances and if funds are available.
7. Have you taken all reasonable actions to reduce costs
- Will insurance cover the losses you have experienced? (if no please explain why)
- Are you registered for Business Rate relief whilst premises are empty?
- Have you needed to reschedule any financial arrangements with your bank?
8. Extent of other public funding in the past three years?
In order to offer public grant we need to ensure that a business has not received in excess of £145,000 cumulatively over the last three years.
Please complete the declaration and information below to evidence this.
I declare that we have looked at all our funding agreements and related documents for the past three years and confirm that:
No funding from state resources was provided to us expressly as De Minimis in the past three years.
The following amounts were received by us expressly as De Minimis in the past three years:
PayerAmountDate
C. Details
Number of full time equivalent employees currently / Number of full time equivalent employees pre crisis / Turnover last financial year / £
D. What are you applying for?
Please see Guidance Notes for information on eligibility, what you can apply for and how much you can apply for.
Grants of up to £10,000 are available to aid the recovery of your business depending on turnover and number of employees.
Lancashire Business Growth Hub can provide assistance on eligible costs and give general business advice. They will also make contact with you later on to check how your business recovery is progressing and provide further advice.
Please list the items you are applying for and the amount. Please note reclaimable VAT is not eligible.
Item / Cost £
£
£
£
£
£
£
Total cost / £

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Application form FRG V1 11.12.15

E.Outputs
Please briefly state below what outputs you hope to achieve through this grant (your adviser will help with this)
Number of Full Time Equivalent Jobs Safeguarded:
______
£ of Annual Turnover Safeguarded:
£______
Number of People Trained:
______
Others:
______

F. Local Authority Liaison Officer declaration

I verify that to the best of my knowledge the answers given above are true and correct
I confirm that I consider the costs of the project reasonable
Signed / Date
Name
G. Declaration of Applicant
I confirm that all information contained within this application is true and accurate
Signed: / Date:
Print Name:

When completed, please scan and email to attaching your current certificate of business insurance (or notify us that you were not insured) and Grant Applicant Information Form.

Email to with the title

Flood Recovery Grant Scheme

Tel: 0800 488 0057

Closing date for applications: 28/02/2016

If successful in obtaining the grant a Local Authority Liaison Officerhas the right to confirm that the grant was spent on the activities identified above and has the right to ask for the monies to be repaid if no receipts have been kept or monies have not been clearly spent as agreed/intended.

DATA PROTECTION

All information provided on this form will be treated confidentially and be processed by Boost, Lancashire's Business Growth Huband other partners in accordance with the Data Protection Act 1998. It will be used for the purpose of providing support for businesses and for impact monitoring and lobbying in relation to the flooding crisis.

If you would not like us to inform you about goods and services that may be of interest to you, please tick the box [ ]

Under the Data Protection Act 1998, you have the right to request access to your personal data.

Write to: Boost, Lancashire's Business Growth Hub, LCDL, County Hall, PO Box 78, Preston, Lancashire PR18 XJ

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Application form FRG V1 11.12.15