Retail relief application form

PART 1: State Aid De Minimis Declaration

You are being considered for assistance under the De Minimis Regulation (Regulation 1407/2013). Specifically, you are being considered for a non-domestic rate discount due to the retail nature of your business. The De Minimis Regulation allows an enterprise to recieve up to €200,000 De Minimis aid over any period of three fiscal years (as set out in EC Regulation 1407/2013 as published in the Official Journal of the European Union on 24 December 2013).To establish whether you are eligible to receive De Minimis aid you must declare the full amount of De Minimis aid which you have already been granted during the previous two fiscal years and the current fiscal year. Any assistance you may have received from a public body might be a De Minimis aid. This could be from central, regional, devolved governments or agencies or a local authority.

Please tick one declaration

I have NOT received De Minimis aid in any of the last three fiscal years (Please go to PART 2)I have received De Minimis aid in the last three fiscal years (Please complete the section below, before moving onto PART 2)

If you have received De Minimis aid in the last three fiscal years, please state the amount of the aid provided, its nature, the provider, and the date received:

PART 2: Business Details

Billing Number

Business Name

Please provide a brief description of the nature of the business and what services are provided.

Your Name

First

Last

Position in Company

Email

Phone

Property Reference Number

Property Address (the property for which you are applying for relief)

Address Line 1

Address Line 2

City

County

Postcode

Country

Declaration

I certify that full details of any assistance received under the De Minimis aid scheme have been declared above, and where no aid has been received, I have stated so. I declare all particulars are correct, and understand that if I supply incorrect information it will invalidate my application.