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For information regarding our privacy policy and how we handle your information, please read our Legal Notices.

* - required information

Company
Name: *

Company: *

Type: *

Address 1: *

Address 2:

Town: *

County: *

Post Code: *

Telephone Number: *

E-mail Address:

How many people does the company employ?

What is the industry sector of the company?

If other please specify:

Is the company’s balance sheet £30M or more?

Is the company’s annual turnover £35M or more?

Do other firms own more than ¼ of the company?

Have you received any state aid in the last 3 years?

If you have received grants or state aid in the last three years:

Payment 1
Date of payment:

Name of provider:

Type of Grant/Aid:

Amount £:

Brief reason for payment:

Payment 2
Date of payment:

Name of provider:

Type of Grant/Aid:

Amount £:

Brief reason for payment:

Disability
Are you registered disabled?

Ethnicity

Choose ONE section from A to F, and then tick the
appropriate box to indicate your ethnic group.
A: White

British

Irish

Any other White background

Please write in

B: Mixed

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed background

Please write in

C: Asian or Asian British

Indian

Pakistani

Bangladeshi

Any other Asian background

Please write in

D: Black or Black British

Caribbean

African

Any other Black background

Please write in

E: Chinese or other ethnic group

Chinese

Any other

Please write in

F: I choose not to disclose this information

No information given

Referral
Where did you hear about us?

Please write in

Disclaimer
The decision on whether to accept or follow any advice offered by us or by our Providers is solely yours. Therefore, you agree that we shall not be liable for direct, indirect or consequential loss you may suffer and that you shall have no redress against us, our Accountable Body or our Providers arising from any advice we provide (or fail to provide) or actions you may or may not take based on our advice. You agree that we can contact you again in 3 to 6 months time to find out how you have developed your business based on the advice provided by us.

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