1Your details 2Details of your business 3Summary Progress Your details Before you begin The fund is not available to businesses who were eligible for either Extended Retail Discount (covering Retail, Hospitality and Leisure), the Nursery Discount or the Airport and Ground Operations Support Scheme (AGOSS). This is a limited fund and only available to businesses that have been adversely affected by the pandemic and have been unable to adequately adapt to that impact. About you Were you trading and registered to pay Business Rates between 1st April 2021 and 31st March 2022? Yes No Sorry, you do not qualify for a relief under this scheme. Please provide your Business Rate Account number (in the format 900000000) What is the nature of your business? How many people do you employ? First name Last name Name of business/limited company Provide your businesses trading address Postcode Find Address Loading addresses... Select Address -- Please select -- Address line 1 Address line 2 (optional) City Postcode Clear postcode/address Use the Lookup Postcode button to find the address.If you cannot find the address, please enter it manually Provide your business contact address (if different) (optional) Postcode Find Address Loading addresses... Select Address -- Please select -- Address line 1 Address line 2 City Postcode Clear postcode/address Use the Lookup Postcode button to find the address.If you cannot find the address, please enter it manually Email Contact number No information is required, please proceed to the next page. Details of your business About your business Please provide information on how your business has been affected Please provide any relevant evidence to support the impact on your business This can be accounts showing your turnover was reduced, or bank statements showing business activity before the pandemic and now. Scanned images should show the business name and account number, if possible. What is your Company Reference Number? What is your VAT Registration Number? What is your Self-Assessment/Partnership Number? (optional) What is your National Insurance Number? What is your Registered Charity Number? (optional) Declaration By submitting this form, you declare that: I confirm I am authorised to submit this application form on behalf of this business I declare that my business meets the criteria for the Covid 19 Additional Relief Fund and the information I have provided is complete and accurate I confirm that, including the payment of this grant, my business will not breach the Subsidy Control You must agree to all of the above declarations in order to submit your application. No information is required, please proceed to the next page. Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page Loading form summary...