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Business Rates - Small Business Rate Relief Form

This form should be completed by the ratepayer. As a minimum, fields marked with a • must be completed.

Business Rates Reference Number

• Full name (including trading name and/or Company Number)

• Full Address

• Do you own any other business in England?

• If the answer to the last question was yes then please provide full address(s) and RV(s)

• From what date do you wish to make your application? (dd/mm/yyyy)

Declaration

I confirm that the properties (hereditaments) listed above are the only business properties (hereditaments) in England occupied by

• Enter Full name of ratepayer

• Position held in relation to the above business

How can we contact you?

In case of any queries please provide us with your email address so that we can contact you. Your telephone number will also be useful.

Name

Email Address

Telephone number (including STD, please leave out brackets)

Data protection Act 1998—relevant information given in this form may be disclosed to the Council's Benefits Service or to other council departments.