Discretionary Rate Relief Application Form

Property Address	
	
Name of organisation	
	
Type of Organisation e.g. Not-for-personal-profit; Voluntary & Community Organisation; Registered Charity; etc.	
	
Are you a Local or Regional / National Voluntary & Community Sector (VCS) Organisation?	

Part One – Describe your organisation	
Please provide the information requested below to the best of your ability as this will have an impact on any relief you may be entitled to.	
	Questions	
1.	Please indicate by inserting a  the percentage of services / activities you deliver from the property / premises that  directly benefit Solihull residents and communities:
	
	0%			1 – 24%			25 – 49%			50 – 90%			90 – 100%		

	
2.a.	Please indicate by inserting a  if you have a contract / Service Level Agreement (SLA) with either or both the following:
	
	Solihull Council			Another Public Body in Solihull e.g. The Solihull Partnership, Primary Care Trust, Solihull Community Housing, etc.			

b.	If  inserted, can you say what contracts / SLAs you have in place, who with and how much you receive per annum?  In addition, if the contracts / SLAs are with another Public Body, can you state what services have been agreed to be delivered through them?	

		
		
c.	If you have any of the above contracts / SLAs, do you receive any financial assistance towards the costs of the rates / property and can you state how much per annum?	

		

3.	Do you receive any other direct funding / financial assistance from Solihull Council?  If yes, can you state how much, for what services and which department of Solihull Council?	

		
		
4.	Do you receive any other indirect benefit / assistance from Solihull Council?  If yes, can you state what they are and if they are quantifiable?	

		

5.	Do you receive funding from any other sources?  If yes, can you state how much, from which funding organisation and over what period?	

		

6.	Do you have any other income?  If yes, can you state how much income and from what activities / services?	

		

7.	How does your organisation fit in with the priorities outlined in our Council Plan (see link: Solihull Council Plan 2020 - 2025: 2022/2023 Update )	

		

8.									
	How many… 	a.  …paid staff do you employ?			b.  …volunteers do you use per annum? (average)			
									
	c.  …of your employees / volunteers are residents of Solihull?		d.  …of the clients you see are residents of Solihull?		e.  …of the clients you see have benefited from a service you provide?		

									
									
9.	Please provide details of your organisation’s successes, and how this has / will benefit Solihull residents?	

		

10.	Where applicable, do you offer any concessions to vulnerable clients?	

		
		
11	Please give details of any work you have carried out to raise revenue or deduce costs:	

		

12.	Are there any specific equality and diversity benefits arising from the services you provide?	

		
13.	Please supply your audited financial accounts for the last 2 years.		

									
14.	Any other information? Please provide.		Yes			No					

		
Part Two – Declaration	
The declaration must be signed by a main contact person or another authorised person from your organisation.  You must agree that the information provided is to the best of your knowledge (and you have authorisation from your Trustees or Board or Management Committee to impart the information for the purposes contained within this form). 	
	
Title	Forenames (in full)	Surname	
					
Position in organisation	
	
Telephone number	
		
Signature	Date	

Part Three – For office use only	

	

	

	

Form reviewed on (date)	

Solihull Council contract / SLA(s) confirmed	

	

	

	

	

What  is the score ?	
	
Any financial assistance towards cost of rent 	

5	
	
4	
	
3	
	
2	
	
0	

	

	

	

	

	
	
Any other direct / indirect funding received from Solihull Council checked	

	

	

	

	

	

	

	

	

	

	

	
	
Have the organisation applied for rent relief?	

	

	

	

	

	

Total (%) rate-relief  grant	

Building occupied	

Rates before grant (£)	
	
Rates after grant (£)	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Data Protection - Fairer Processing Notice
Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services, reliefs or exemptions you may be entitled to or interested in.  We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires.  For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk or contact systemscontrol@solihull.gov.uk