Non Domestic Rates Account Number * Please see your latest Business Rates bill or e-bill sent By completing this form you are confirming that the registered business named below shall comply with the cash cap on claiming the Expanded Retail Discount on the basis that, including this award, (together with any other companies in the same Group) shall not receive (from 1 July 2021 onwards) more than £2 million of Expanded Retail Discount in 2021/22 for properties which based on the coronavirus rules at 5 January would have been required to closed and £105,000 for other eligible properties (up to a cap of £2 million for all properties)within 2021/22. See guidance on the cash cap in the guidance for the Expanded Retail Discount. Value of Expanded Retail Discount * See value in email sent Property Reference Number * See property number on email sent Local Authority providing aid Name * Please provide your full name Position * E.g. Director, Sole Trader Business * Registered name of the business which may not be the name you trade as Address 1 * Address 2 Town/City * Postcode * Registered business address which may not be your trading address Date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20212022202320242025 Declaration * Please tick both options I confirm that I am authorised to sign on behalf of the business;and The business shall not exceed Expanded Retail Discount Cash Cap by accepting this Discount I accept that Surrey Heath Borough Council gathers, stores and processes my data in order to deliver their services to me. Surrey Heath Borough Council will minimise the amount of gathered data and processing of it based upon local and EU GDPR legislation. For information about how we use your data, please see our privacy notice. GDPR consent accept * I give my consent to Surrey Heath BC to gather and process my data