APPLICATION FORM FOR RURAL RATE RELIEF

Only for Village Shops, Food Stores, Post Offices, Pubs and Filling Stations

Notes to help you: a) First of all, please read our letter about Rate Relief for Rural Businesses that came with this form. b) Fill the form in by answering ALL the questions and give any information that you think is relevant. c) We will consider all the information you supply and then write to let you know how much relief, if any, we can give. d) Sometimes, we might have to ask you for more information before we can decide how much relief to give. e) We will send you one of these forms before the end of every year if you can have this relief – this is so that you can reapply for the new year.

1 Name of the Ratepayer.

2 Rate Account No: *

* 3 Property address * *

4 Describe the type of business being run from the address in section 3.

(Examples - shop, food store, post office, pub, filling station)

5 If the business is a shop or food store, please list the full range of goods or types of food that you sell.

Otherwise, please mark this section “Not Applicable”.

(continued on the back) 6 Which settlement is the business in?

(Please pick from the list at the bottom of this page.)

7 As far as you know, is yours the ONLY business of this type in the same settlement?

(* If NO or NOT SURE, please give further details in this box.) DECLARATION 8 I confirm that to the best of my knowledge the information I have given on this form is true and complete. I give the Council permission to check the information if they wish to do so. I will tell the Council, in writing and straight away, if anything changes that could affect my business getting the relief I am applying for. In particular, I will tell the Council if another business of the same type starts to trade in the same settlement as mine.

Signature: ……………………………. Full Name: …………………………………….

Date: ………………………………. Contact telephone No……………………….

E-mail address : ……………………………………………………………..

9 Please return this form to South Holland District Council, Revenues Section, PO Box 8, Priory Road, Spalding, PE11 2XQ.

OUR RURAL SETTLEMENT LIST

01 Village 17 Drove 31 Shepeau Stow 02 Village 18 Holbeach Hurn 32 Village 03 Donington Village 19 Holbeach St Johns 33 Surfleet Seas End 04 Fleet Church End 20 Holbeach St Marks 34 05 Fleet Hargate B Hop Pole 35 06 Gedney Black Lion End 21 Little Sutton Village 36 Throckenholt 07 Gedney Church End 22 Lutton Village 37 08 Gedney Dawsmere 23 Lutton Gowts 38 Tydd Gote 09 Gedney Drove End 24 Moulton Village 39 Village 10 Gedney Dyke 25 Moulton Chapel 40 West Pinchbeck (sub-divided) 11 Village 26 Moulton Seas End 41 Weston Village 12 Village 27 Nene Terrace, 42 Weston Hills – Austendyke 13 Gosberton Clough (sub-divided) 28 Northgate (sub-divided) 43 Weston Hills – St Johns 14 Gosberton Risegate (sub-divided) A Pode Hole 44 Village 15 Holbeach Bank (sub-divided) 29 Village 45 Whaplode Drove 16 Holbeach Clough (sub-divided) 30 Saracens Head (sub-divided) 46 Whaplode St Catherine C Penny Hill For official use only RV: £ ACC: Settlement Code From List: Type: PRN: Mand /Disc: / % Authorised By: Certified By: Entered By: Date: Date: Date:

(2015VSRRappl)