Somerset Start Up & Grow_Client Registration & Subsidy Control Form

Client Registration and Subsidy Control Form
Your Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Phone Number*
Email*
Age Group*
Gender*
Ethnicity*
Do You Consider Yourself to Have a Disability?*
Business Details
Business Name*
What does your business do?*
Date Business Commenced Trading - if not yet trading please put date you intend to start*

DayMonthYear
Date
UTR* or Company Registration Number - if you are not yet trading please write 'pre-start'*
*Your Unique Taxpayer Reference (UTR) is a unique number that you will have received when you registered with HMRC. It will be the last 10 digits of your ‘Reference Number’.
How Many Staff Does Your Business Employ? (Full Time Equivalent)*
Disclaimer Notices

I hereby request the services and support provided under this programme. I understand that every effort will be made by the delivery partners and their employees, servants, or agents, to ensure that all information, advice and other services given during the course of our services shall be accurate.  However, I accept that Somerset Council and its delivery partners shall have no legal responsibility or liability for any errors or omissions in the information, advice or services provided and no responsibility or liability is accepted with regard to the stand of any Firms, Companies, or individuals mentioned during the course of our service. I also confirm that I am in agreement for my Personal Information to be held for the benefit of this project.
Information Sharing

The personal and business information that we hold on you will not be passed to any other organisation that is not involved in providing your business support through the Somerset Council business support programme. However, the information in part will be shared with Somerset Council and UKSPF as funders of the business support to enable them to collate reports on national and regional activity. In accordance with Data Protection regulations, any data on individuals will not be shared with anyone else without the express permission of the individual in question. If, however, we feel that it is necessary to share your personal data with professionals to ensure you or someone you work with is safeguarded from harm, we rely upon the provisions of the Safeguarding Vulnerable Groups Act 2006 and Children Act 1989 & 2004. The data we hold on you, relating to this programme of support will be held for 7 years. 
Declaration

By signing this form I consent to Somerset Council and their delivery partners holding and sharing relevant information as detailed above. I agree to participate in the programme & understand my participation is voluntary and I am free to withdraw at any time without giving any reason and without my rights being affected.  I consent for my contact details to be shared with third parties for research purposes only. 
Subsidy Control Declaration - MFA Notification

This declaration states the value of support you can receive through this programme from the business advice and workshops. It is not a grant and you will receive no financial support under this programme.
This programme offers a Minimum Financial Assistance (MFA) subsidy under the Subsidy Control Act (2022), subject to your agreement to, and compliance with, the terms and conditions set out below relating to MFA.

The amount of MFA offered is £477.91. Before making the payment, we require written confirmation that receipt of the payment will not exceed the enterprises MFA threshold of £315,000 cumulated over this and the previous two financial years, as specified in section 36(1) of the Subsidy Control Act (2022). This means you must confirm that your business* has not received more than £314,522.09 in MFA subsidies or comparable types of subsidies (see section 42(8) of the Subsidy Control Act) between 1 April 2023 and this date.

* The MFA financial threshold applies at company group level

Having read the above, please complete the statement below confirming your business’s eligibility for support. I confirm that the business has received the following De Minimis or MFA aid during this financial year and the previous two financial years:

Rows	Organisation providing the assistance/aid	Value of assistance (£)	Date of assistance	Nature of Assistance
1
2
3
4
5

I can confirm that no MFA Aid has been received during this financial year and the previous two financial years
We take this opportunity to remind you that you are required to keep a written record of the amount of MFA you have received and the date/s when it was received. The written record must be kept for at least three years beginning with the date on which the MFA was given. This will enable you to respond to future requests from public authorities on how much MFA you have received and whether you have reached the cumulative threshold.

Confirmation must be from someone who is authorised to do so on behalf of your organisation.

I confirm, for and on behalf of, the enterprise named above that receipt of MFA of £477.91 will not exceed the MFA threshold specified in section 36(1) of the Subsidy Control Act (2022).
Name*

First NameLast Name
Position in Business*
Signature*
Date*

DayMonthYear
Date
WDBIP426B
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Client Registration and Subsidy Control Form

Your Information

Business Details

Disclaimer Notices

Information Sharing

Declaration

Subsidy Control Declaration - MFA Notification