Childcare Provider Grant

Your Personal Information

Title

First Name

Surname

Address line 1

Address line 2

Address line 3

Town

Postcode

Relationship to business

Contact telephone number

E-mail address

Age

Do you consider yourself as:

Are you a Welsh speaker?

Information about your business

Business Name

Type of Childcare business

Street

Town / City

Local Authority

Postcode

CIW registration number

HMRC Unique Taxpayer Reference or PAYE reference (if applicable)

Annual turnover for 2019/2020 tax year

Projected annual turnover for 2020/2021

Number of Childcare Places

Number of employees

Date business started trading

Please outline any Childcare Offer, Flying Start, Foundation Phase Nursery or Coronavirus Childcare Assistance Scheme (C-CAS) funding you have received for the period 1 April 2020 to 30 June 2020, including any amounts paid arrears due to be paid after June: Please provide details of which scheme(s), dates received and the amounts received from each scheme:

Please explain how the viability of your business will be affected if you do not receive the grant:

Have you received De Minimis Aid during the previous 3 fiscal years (i.e. current fiscal year and the previous two fiscal years):

Coronavirus Job Retention Scheme (CJRS) declarations

Impact of Covid-19 on your Business

My business has continued to trade normally but has experienced a reduction in income

My business is partially trading

My business has suspended business operations

Has your net income for 1 April to 30 June 2020 reduced compared to the same period in 2019 as a result of Covid-19? (this will need to be evidenced by providing business bank statements for the period 1 April to 30 June for 2019 and 2020). You must include all sources of business income.

The business started trading on or after 2 April 2019 and made a net loss of £………………… for the period 1 April 2020 to 30 June 2020

Bank Statement

Additional information regarding the impact on your business

Your Business Bank details

Bank Name

Account Name

Account Number

Sort Code

Please provide a business bank statement as evidence

Bank Statement

Declarations

I confirm that the information I have provided is true and accurate to the best of my knowledge.
I confirm that I have read and understood the Childcare Provider Grant Guidance document.
I confirm that my business operates in Wales.
I confirm my business will undertake the obligations of the scheme outlined on the application form and in the guidance notes
I acknowledge that my local authority or the Welsh Government will undertake any appropriate business checks considered necessary to assess the application and to check the nature, use and impact of the funding in the future.
I confirm that without the grant the viability of my business will be under threat as a result of the Covid-19 pandemic.
I confirm that our Coronavirus Job Retention Scheme (CJRS) declarations are up-to-date and copies have been provided with the application.
I confirm that I am not in receipt of the Self Employment Income Support Scheme, Economic Resilience Fund, the Business Rate Grant, Welsh Government Start Up Grant, Coronavirus Business Interruption Loan Scheme, Bounce Back Loan Scheme, Third Sector Resilience (WCVA) Fund or the Mudiad Meithrin grant scheme.
I confirm that I have provided all required evidence to support my application for the Childcare Provider Grant.
I confirm that I will register for Business Wales support if my application for the Childcare Provider Grant is successful.
I confirm that I have read and understood the Privacy Notice of the Childcare Provider Grant: https://gov.wales/childcare-provider-grant-privacy-notice

I can confirm to all the statements above.

If you are unable to confirm to all the statements above, you are not eligible for the scheme.

When submitting your application, please remember to attach all the required evidence documents, including proof of identification, proof of business address and bank statements. Further details can be found in the guidance document.

Welsh Government reserves the right to recover funding from individuals and businesses where false information was provided or where upon further checks, the business is not eligible for the scheme. Welsh Government may refer potentially fraudulent claims for criminal investigation.