1Page 1 2Page 2 3Summary Progress Page 1 Business eligibility Eligible businesses in the hospitality, leisure and accommodation sectors can use this form to apply for a one-off grant under the Omicron Hospitality and Leisure Grant scheme. Were you trading and registered to pay Business Rates on 30 December 2021? Yes No Sorry, you do not qualify for a payment under this scheme. Please provide your Business Rate Account number (in the format 90000000) What is the sector of your business? Accommodation Leisure Hospitality What is the nature of your business? -- Please Select -- Amusement arcades Amusement parks Arenas B&Bs Boarding houses Cadet huts Cafes Campsites Canal boats or other vessels Caravan parks Caravan sites and pitches Casinos and gambling clubs Catered holiday homes Chalet parks Cinemas Clubs & institutions Coaching inns Concert halls Cottages or bungalows Country house Events venues Food courts Guest houses Holiday apartments Holiday homes Hostels Hotels Lodge Museums and art galleries Night clubs & discotheques Public houses/pub restaurants Restaurants Roadside restaurants Soft play centres or areas Stately homes & historic houses Theatres Zoos & safari parks Theme parks Tourist attractions Village halls & scout huts Wedding venues Wine bars How many people do you employ? Your name Name of business / limited company Date business was established Provide your business' trading address Provide your business' contact address (if different) Email Contact number Further details Please select all of the following that are applicable to you or your business At least one option must be selected Company Reference Number VAT Registration Number Self-Assessment / Partnership Number National Insurance Number Registered Charity Number What is your Company Reference Number? What is your VAT Registration Number? What is your Self-Assessment / Partnership Number? What is your National Insurance Number? What is your Registered Charity Number? You must select at least one of the options above in order to proceed with your application. Have you received any previous funding under other Covid 19 business grant schemes? Yes No Please confirm the last 4 digits of the bank account this grant was paid into No information is required, please proceed to the next page. Page 2 Bank details Name of bank or building society Account holder's name Account number Sort code You will need to send a business bank statement which is no more than 2 months old to support your grant application. If you are entitled to a payment, we will pay it into this bank account. Declaration By submitting this form, you declare that 1. I confirm I am authorised to submit this application form on behalf of this business and consent to this information being shared with a third party agency for verification purposes 2. I declare that my business meets the criteria for a Omicron Hospitality and Leisure Scheme payment and the information I have provided is complete and accurate 3. 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...