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LRSG Closed - Grant Payment Form

Only complete this form if your business is closed due to lockdown restrictions with effect from 5th November 2020 (full guidance on previous page).

Your business must be registered for business rates and fall into one of the following categories:

  • Retail
  • Hospitality
  • Leisure
  • Personal Care


  • The business was open and trading as usual on 4 November 2020, and
  • It is one of the types of business that have been instructed to close, and
  • Your business will be closed for the 4 week lockdown

The Covid Grants team are working through the applications received and if additional information is required to be able to assess your application we will be in touch.

Applications will be assessed, the required checks will be carried out and we will contact you with a decision on your application. Please be aware that we are anticipating exceptionally high levels of service demand at the moment and we aim to provide you with an outcome of your application as soon as we can.


Title eg Mr, Mrs...
Please note if your business does not fit into the above categories, you are not eligible to claim this grant.
(If applicable)
(If applicable)
(if applicable)

In completing this declaration, I acknowledge:

  1. The state aid de minimis threshold has been extended to €800,000 euros and it is your responsibility to ensure you do not exceed the threshold. If you feel obtaining this grant will take you above the state aid de minimis limit you should not complete this form. If you have received grants that take you above the state aid de minimis level you should return the payment, otherwise this may be clawed back at a future date.
  2. I meet the eligibility criteria to apply for a Local Restrictions Support Grant.
  3. Tamworth Borough Council reserves the right to verify any claim or associated expenditure by checking with third party organisations including but not limited to banks, credit reference agencies, information held by the local authority and other local authorities
  4. The information you give us is used and held in accordance with the Local Government Finance Act 1988, and the principles of the Data Protection Act 1998. Requests made under the Freedom of Information Act 2000 may ask for general information regarding limited companies and PLCs which we will supply as they are not covered by the Data Protection Act.  
  5. We have a duty to protect public funds and we may use business rates data in cross system and cross comparison checks to ensure our records are correct. We may also disclose relevant information to other council and government departments where it is necessary and lawful to do so. We may also share information with other bodies responsible for auditing or administering public funds.  
  6. Tamworth Borough Council reserves the right to recover any grant payment where the data provided is later found to be fraudulent or incorrect. 
  7. The payee bank account details provided are the official business account details for the business and I confirm I am consenting to Tamworth Borough Council contacting the above bank to verify the bank account is that of the above business.
  8. Partial completion of this form will result in the application not being processed and I have provided with my application evidence to support my application as required, I understand if I have failed to submit evidence as required my application will not be considered.
  9. Completion of this form does not guarantee a grant and is subject to final approval against current government eligibility criteria and anti-fraud checks and I understand Tamworth Borough Council will make the final decision as to the payment of any grant.
  10. I declare that the information I have given in this form is correct and complete. I will tell the Council if there is any change in circumstance.