Business Support Grant Claim Form

This form is secured using HTTPS and TLS. Details you submit are encrypted between your computer and Cyngor Gwynedd’s network. The Council’s computer systems ensure that only authorised staff have access to your details.

Business Details

Non Domestic Rates Reference *

Business Name *

Company Number (if Limited)

Address (line 1)

Address (line 2)

Address (line 3)

Post Code

Description of business *

Website

E-Mail *

Confirm E-Mail *

Phone number *

Contact details (if different to above)

Address (line 1)

Address (line 2)

Address (line 3)

Post Code

E-Mail

Confirm E-Mail

Phone number

Bank Account Details to pay the grant

Bank Name *

Bank Account Number *

Sort Code *

Applicant details

Full name

Position in business

Information about your business

Declaration:

If you have received a separate Covid-19 related grant, including from the Welsh Government's Economic Resilience Fund, you must declare it.

What other funding have you applied for directly related to the Covid-19 crisis prior to submitting this application (e.g. Welsh Government Economic Resilience Fund grant)?

How much did you apply for?

How much have you been awarded?

As the person named in this application, I declare the information provided in this application is true and accurate, to the best of my knowledge, and the provision of any false information may result in action for recovery of the grant. *

De minimis support

This grant is being provided to you as de minimis aid under EC Regulation 1407/2013. You can find out more about what this is here: 'De minimis aid summary'.

A grant provided to you under this scheme will be relevant if you have applied or are planning to apply for support in the future under de minimis.

The value of the support you are receiving under this scheme will be either £10,000 or £25,000 depending on which grant you qualify for.

You will need to declare this amount to any other support agencies that ask you how much de minimis aid you have had. (‘De minimis’ is a rule that permits businesses to receive public support of up to €200,000 - approximately £177,000 - over a three year period. If you have received aid under the ‘de minimis’ rule it will be stated on the correspondence offering the aid to you. For the purposes of the de minimis Regulation, you must keep a record of this grant for 3 years from the date you receive it.

Has your business received any public sector assistance through a State Aid de minimis scheme over the past 3 years? *

Yes

If you have answered Yes you need to provide details:

Body providing the assistance / aid

Value of assistance

Date of assistance

I confirm that I understand, and agree to the terms and conditions of support, and confirm that the details on this form are correct *

Confirmation of State Aid received under the Covid-19 Temporary Framework for UK Authorities measure and Undertaking in Difficulty Status

The Euro equivalent of the Sterling aid amount is calculated using the Commission exchange rate applicable on the date the aid is offered. Any aid provided under this measure will be relevant if you wish to apply, or have applied, for any other aid granted based on the European Commission's Temporary Framework. You will need to declare this amount to any other aid awarding body who requests information from you on how much aid you have received. You must retain this information for four years after the conclusion of the UK's transition from the EU and produce it on any request from the UK public authorities or the European Commission.