E-Business Registration Form

Business Registered Name & Trading Name:*

Business Website URL*

Registered Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Address London Borough*

Trading Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Trading Address London Borough*

Company Registration Number/UTR Number*

Type in your Company Number or UTR

Date Business Registered (Must be over 1 month)*

Date

Nature of Business*

Legal Status*

Type of Business*

Business Type

CEO/MD/Owner Name:*

Others*

Is the Business: (i.e 51% owned or senior management team comprises over 51%)*

Number of full-time employees, include yourself*

Number of part-time employees, include yourself*

Number of employees in good jobs, include yourself*

(Good Jobs are jobs over 16hrs per week, for at least 12 weeks, not inc. zero hrs contracts)

Number of green jobs:*

(Green Jobs are jobs that support/contribute to UKs emissions target & other environmental goals)

Turnover for this financial year*

In the next 12 months, I plan to: (Tick all that apply)*

Increase my current turnoverHire new employees/members of staffIntroduce/ launch new service or productsContinue in business/ safeguard current staff positions

If you ticked 'Increase my current turnover' above:*

Contact Mobile*

Please enter a valid phone number.

Contact Email*

example@example.com

Business Email*

example@example.com

Would you like to opt in to our mailing list?*

Are you a resident of Kensington and Chelsea*

YesNo

About You*

Age*

Do you have a disability, or a health condition as defined in the Disability Discrimination Act 1995? (Physical or mental impairment with ‘substantial long-term’ negative effect on ability to do normal daily activities).*

If you have specific requirements, please speak to your Adviser about any ways we can support you.

Ethnicity*

Data Protection & Declaration
The LONDON E-Business Support Programme is funded by the UK government through the UK Shared Prosperity Fund. The organisation collecting this form, PORTOBELLO BUSINESS CENTRE, will store and retain details in accordance with its Privacy Policy which can be viewed at: https://pbc.co.uk/our-privacy-and-cookies-policy/. This data will be shared with the Lead Partner managing the programme, Enterprise Enfield, who will retain information in accordance with its Privacy Policy which can be viewed at: https://www.enterpriseenfield.org/privacy-policy. London Business Partnership is a member of the Business for London consortium of partners who are delivering this programme.

By enrolling you also agree that your information may be shared with the programme funders including: UK Government; the GLA (Greater London
Authority); DLUHC (Dept for Levelling Up Housing and Communities); Government Departments and Mayor of London. The GLA may also share information with relevant organisations and partners, additionally data will be shared with auditors and programme evaluators. All Programme data will be retained until 31/3/2031.

I agree to provide data concerning the company and its employees as requested by the Programme, and to partake in any evaluations to ascertain the benefits of the Programme. I shall provide data about my business so that the Programme can demonstrate that project activities were carried out in compliance with terms and conditions of their agreement and contract with the GLA. I confirm that all information set out in this form is true and accurate and that the information given by me may be used in the ways set out above.

I tick the box below to confirm that I have read, understood and agree to abide by the terms of this agreement.

Name*

First NameLast Name

Position*

Date*

Date

London E-Business Support Programme Registration Form