South Gloucestershire



Application form for Help us Thrive Fund To be read in conjunction with the Guidance notes1.Applicant detailsName of Business or Community Organisation:Registered address/postcode:1.3 Your name:1.4 Contact telephone number:1.5 Email address: Website link / facebook page Nature of business or organisation Legal status of your organisation: (Ltd company/ LLP / Sole Trader/ Business Association / CIO / CIC/ Franchisee / Charity / Unincorporated community association / town & parish councils)2Project name 2.1Project purposeProvide a concise description of the purpose of your project, detailing what it will achieve and how it will benefit the high street based upon the themes in the guidance notes 2.2How many jobs will be protected or created as a result of this project?2.3Which high street will your business or community organisation enhance? 2.4Planned project start date: .../.../...Planned project end date: .../.../...3Finance3.1Full cost of project?0.003.2In the table below, confirm your funding request and detail the items you will spend the fund allocation on:ItemExpenditure ?Total LOHS Fund requested0.003.3All applications in excess of ?5,000 should have some form of match contribution, or in-kind contribution identified. List other sources of funding towards your project.SourceValue ?Total match funding0.003.4 What was the turnover of your organisation/business in the last 3 financial years and how many people were employed by the organisation (directors and staff)?YearAmount ?Employment numbers2018/192017/182016/173.5 If you are a new organisation, please tell us the date you commenced trading3.6In the table below, detail the value of other financial support and particularly State Aid that you have received this year since March 2020 (e.g. furlough scheme/other business support/other grants).Source of fundsValue ?Total 0.004Strategic value4.1There are four main fund themes; indicate which of these your project will contribute to (refer to guidance notes)LOHS grant themesYour contributionDiversified and densified high street mixC21st / Future focussed high street that maximise the use of new technologyHigh Street that supports localism and social inclusionGrowth of existing employment centresSupporting community, independents and small businesses5Permissions and insurance policies5.1What insurance cover does your organisation hold? Please indicate the value of cover against all that apply. Buildings and contents?Employers’ liability?Public liability?Professional indemnity?Other (please specify)6Monitoring and evaluation6.1Outline the plans you will put in place to monitor and evaluate your project so that you can track expenditure, delivery and service improvement. Also comment on what systems you will put in place to support this monitoring so that you can report your achievements to the Council.7DeclarationI confirm that:I am authorised to sign on behalf of the above named organisation and will only be used for the purposes specified in the application.I agree to the use of my personal data in line with South Gloucestershire Council’s Privacy Notice.I declare that, to the best of my knowledge, all statements and representations made in connection with the data are true, accurate and correct.Your name:Position:Date:Please reply by the 28 February 2021 sending the completed form and supporting documents to: Highstreets@.uk ................
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