Low Carbon SMEs Registration Form

Thank you for your interest in the Low Carbon SMEs programme. This project is part-funded by the European Regional Development Fund (ERDF).

Please make sure the information you provide is complete and accurate. You will need to submit this form with your signature. If you have any question/issues, please do not hesitate to contact us. Please email smelowcarbon@aston.ac.uk /call 0121 204 3480.

We look forward to supporting you.

About your business
Business Name *
Full business name as registered
Telephone *
Website
Current Address *

Street Address

Street Address Line 2

City

Post Code
Company House Registration Number *
Standard Industrial Classification Code (SIC Code)

Business contact (Owners/Directors/Partners)
1. Main Contact (Owner/Director) Full Name *
Position *
Landline No./Mobile *
E-mail *
2. Other Contact Full Name *
Position *
Landline No./Mobile *
E-mail *
example@example.com

Small or Medium Sized Enterprise (SME) Declaration
Please Note: All data must be related to the last approved accounting period and calculated on an annual basis. In the case of newly-established enterprises whose accounts have not been approved, the data to apply shall be derived from a reliable estimate in the course of the financial year.
Do you employ fewer than 250 people? *

Yes No
Is your annual turnover less than 50 million Euros? *

Yes No
Is your balance sheet total less than 43 million Euros? *

Yes No

State Aid
You are applying for assistance under the European Commission’s De Minimis Regulation. In case of this particular programme, it must comply with De Minimis state aid regulations (EC regulation 1407/2013).This allows a company to receive up to 200,000 Euros of public aid over a three-year period. To confirm that you are able to receive assistance from the Project, you must declare the full amount of any support you have received over the last 36 months.

Completion of diagnostics is expected to take between 2-5 days. The estimated value of support is £470.52 per day (approximately 6 hours). Therefore, the total value for 12 hour of diagnostic support will be approximately £941.04. The total value in Euro (€) will be based on the European conversion rate at the time of support. The maximum value of the diagnostic support for 5 days (approximately 30 hours) is likely to be £2,352.60. The total value in Euro (€) will be based on the European conversion rate at the time of support.

For long term collaboration projects, the value of support will be up to the value of £789.18 per day. Therefore, the estimated value of state aid accrued for the Long-term collaboration support for maximum of 10 days is approximately £7,891.80. The total value in Euro (€) will be based on the European conversion rate at the time of support.

As per the regulation, this value is calculated by the market value of the support, and not necessarily the actual value of the support provided by the advisor. For further details please visit https://www.gov.uk/guidance/state-aid.
Has the company received state aid as grants, consultancy support etc. inthe last 3 years? If yes, please provide further details below for all the businesses you own. *

Yes No
If Yes, Please specify the following:
If Yes, Please specify the following:
If you would like to add more State Aid, please click add more and fill the details in the above sequence.

Any other information
Is there any other information that you would like to share with us?
Please include relevant documents to confirm State Aid
Did you have any problem while filling out this form? If so, please let us know
How did you hear about the programme

Growth Hub (Birmingham & Solihull LEP) Growth Hub (Black Country LEP) Low Carbon SMEs Website Low Carbon SMEs Event/Workshops Social Media An Event/workshop

Equality and Diversity Monitoring Form
Monitoring race, gender and disability is a requirement for ERDF funded programmes. We are monitoring the companies that use the Low Carbon SMEs Project, to have a better understanding of the profile of our client base; your co-operation will help us to do this. The specific information received will not be shared outside of the Project. It will not be used to decide if you are eligible for the programme.

The European Union, which is part funding the Low Carbon SMEs project, requires evidence that the project activities are open to all. The information requested is provided on a confidential basis and we will only reveal it in aggregate form. The exception to this is in relation to project auditors who will be able to view all the project administration records.
Please let us know, if you would like to complete the Form *

Yes No
Gender

Male Female
Age
Ethnic Origin
If 'Other', please specify:
Are you a disabled person as defined by the Disability Discrimination Act?

Yes No
Disability is defined by the Disability Discrimination Act as “a physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. The disability could be physical, sensory or mental and must be expected to last at least 12 months.

Data Protection and Disclaimer
We collect personal information about you, on behalf of The Ministry of Housing, Communities and Local Government (MHCLG), so that we can evaluate this project and to report to the European Regional Development Fund (ERDF) for monitoring and evaluation purposes.

How we use the information you provide-: The details you provide on this form and subsequently provided to the Low Carbon SMEs Project will only be used in connection with services relating to the Project. Your data will be added to the Customer Relationship Management (CRM) database and also paper copies will be maintained. All records will be retained at least until 2033 as required for ERDF funded projects.

We must protect the public funds we handle and so may use the information you have provided on this form for audit purposes. Audits can be undertaken by Aston University staff and external contractors as well as EU Government and European Auditors. Low Carbon SMEs may share required information with Aston University Academics for Research purposes. This will not include any personal data. For further details please refer to Low Carbon SMEs Privacy Policy, please visit http://www.smelowcarbon.co.uk/privacy-policy/
Do you agree to submit this information . *

Yes, I agree / Understand No, I require further information. (If No, please do not submit this form and email your query to smelowcarbon@aston.ac.uk )
We would like to contact you from time to time with details of workshops/webinars that we are running that may be of interest to you. If you consent to us contacting you via email for this purpose, please specify your preference below: *

Yes No
Would you like to receive the Low Carbon SMEs monthly newsletter? If you consent to us contacting you via email for this purpose, please specify your preference below: *

Yes No
Disclaimer: Any support and information provided by Low Carbon SMEs project Advisor(s) and Academic(s) is in good faith at that time. Any action(s) you take upon the information, is strictly at your own risk. Low Carbon SMEs and Aston University will not be liable for any losses and/or damages in connection with the services provided.

In return for access to the support of the Low Carbon SMEs Programme, I agree to provide the project with the relevant information required by ERDF for monitoring, evaluation and as proof of outputs. I certify that the information contained within this registration and declaration form is correct to the best of my knowledge.
I confirm that I have the authority to sign on the behalf of the beneficiary. *

Yes No
Position: *
Date
The Low Carbon SMEs programme is part-funded by the European Regional Development Fund

For Internal use: Low Carbon SMEs only
Project Declaration: I certify that the above organisation is eligible for ERDF support through Low Carbon SMEs Programme

Yes No
Full Name:
Position:
Signature

Clear
Date
Should be Empty:

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