Company Registration Number
Principal Activity of Company
Position
Telephone
Are you a small or medium size enterprise?
YesNo
If Yes please provide details of:
Describe the financial impact of COVID-19 on the company (maximum 150 words):
Up to £1,000 Details of what grant will be spent on
£1,000 to £2,000 Details of what grant will be spent on
£2,000 to £3,000 Details of what grant will be spent on
£3,000 to £4,000 Details of what grant will be spent on
£4,000 to £5,000 Details of what grant will be spent on
Please provide details of current staff numbers and projected staff numbers for the coming 2 years and how you propose to achieve these targets:
Small Business Grant AppliedReceived If yes, what was the value? eg £3000
Small Business Rates Relief AppliedReceived If yes, what was the value? eg £3000
Cornavirus Job Retention Scheme AppliedReceived If yes, what was the value? eg £3000
Cornavirus Business Interuption Loan AppliedReceived If yes, what was the value? eg £3000
Bounce Back Loan Scheme AppliedReceived If yes, what was the value? eg £3000
VAT Deferral Scheme AppliedReceived If yes, what was the value? eg £3000
Self Assessment Payment on Account Deferral AppliedReceived
Value of Grant Applied for (maximum grant £5,000)
Contact Name (required)
Contact Telephone (required)
In addition to the above form to allow us to make the grant funding we require the following documentation, could this information be emailed to : enquiries@opennorthfoundation.co.uk
- Last full annual accounts - Latest management accounts - Copy of latest budgets/cash flows (if available)
If you do not prepare forecasts or budgets please provide details of how you expect the company's results to change over the next two financial year ends, in line with business plan and provide some commentary on how you expect to achieve these results (maximum 250 words):
Has any director ever been disqualified from being a company director under the Company Directors Disqualification Act (1986) or ever been the properietor, partner or director of a business that has been subject to an investigation (completed, current or pending) undertaken under the Companies, Financial Services or Banking Acts? YesNo
Has any director/partner ever been bankrupt or subject to an arrangement with creditors or ever been the proprietor, partner or director of a business subject to any formal insolvency procedure such as receivership, liquidation, or administration, or subject to an arrangement with its creditors. YesNo
Has any director/partner ever been the proprietor, partner or director of a business that has been requested to repay a grant under any government scheme? YesNo
If the answer to any of the above questions is 'yes' please provide details:
I am content for information supplied here to be stored electronically and shared in confidence with other public sector bodies, who may be involved in considering the case. I understand that if I give information that is incorrect or incomplete, grant may be withheld or reclaimed and action taken against me. I declare that the information I have given on this form is correct and complete. I understand that any grant offer, grant receipt and projected use of the grant may be publicised by means of a press release giving details of the project and the grant amount. Yes
Open North Foundation is not a registered charity and is a private company limited by guarantee (Company number 10621351). The objectives of the foundation can be found on our website: opennorthfoundation.co.uk.
