Small Business Bonus Scheme Application Form (Page 4 of 4) in pdf

Small Business Bonus Scheme Application Form Page 4

DECLARATION

Please read this declaration carefully before you sign and date it.

I understand and declare the following:

1. If I give information that is incorrect or incomplete, you may take action

against me including court action.

2. You will use the information I have provided to process my claim for relief

under the Small Business Bonus Scheme.

3. You may check the information provided with other sources as allowed by

law.

4. You may share the information provided with other organisations, such as

other Scottish Local Authorities, Assessors and the Scottish Government.

5. I must let Falkirk Council know about any change in my circumstances, which

may affect my claim, including the occupation/vacation or purchase/sale of

any property I own or occupy in Scotland, which may affect liability for

non-domestic rates relief.

6. I declare the information I have given on this form is correct and complete.

7. Has my business received any

Yes

If yes, how much?

state aid/grants in the last three

years?

Please ensure you enclose a copy of your most recent rates bill for all properties

outwith Falkirk Council Area.

Please sign and date the form, and if signing on behalf of a business please state in what

capacity you are signing e.g. Owner, Director, Manager, Partner, Agent, etc.

Signed for or on behalf of the establishment

Position (Director, Owner etc.)

Date

Daytime Telephone Number

Email Address

Small Business Bonus Scheme Application Form Page 4