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Mr

Miss

Mrs

Ms

Dr

Other
Name of Owner:
Title*
First Name*
Surname*
Mandatory Fields*

Please specify:
Company Name*:

Alternative Telephone
/ Mobile Number
Email Address*
Telephone Number*
County
Town*
Line 2
Line 1*
Postcode*
Utility Supply Address:
Please select your business type (choose one from below):
How many people work in your business?

Yes

No
Do you live at your business address?





Tick as appropriate:
Sole Trader
Partnership
Limited Company
Other
Construction














Information Technology
Education
Leisure & Entertainment
Financial
Legal
Food
Skilled trades
Hair & Beauty
Transportation & Logistics
Health Care Services
Wholesale & Retail
Other
Please specify:

Please complete if you would like to be contacted at a different address from above
Correspondence Address:
Postcode
Line 1
Line 2
Town
County
Telephone Number
Email Address

Business Energy Solutions Fund
Application Form
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Declaration Statement
I consent to the personal details I have provided on this form being:

(1) Shared with my Utility Company in relation to my account and the services provided by them.
(2) Processed by Charis Grants Ltd in accordance with the Data Protection Act and shared with other funds /                   organisations.

If I have obtained personal information about any other person in support of this application, I confirm that I have obtained consent from that person to use and share the information as described above.

I authorise Charis Grants Ltd to contact me directly about my application and declare that the information I have given on this form is complete and correct to the best of my knowledge.

I declare that in applying to the Fund I am committed to achieving future financial stability allowing me to keep up to date with current bills and avoiding getting into debt in the future. I understand that awards will only be granted to applicants who demonstrate their commitment to improving their own personal stability. I understand that Charis will request information about my energy account from my energy supplier, including monies owed and any other information deemed necessary for the purpose of processing this application and I agree for such information to be disclosed.

I wish to be considered for any additional funds, either administered by, or identified by Charis Grants Ltd that I am eligible for.

In order for your application to be submitted, you must attach the Budget Sheet sourced from Business Debtline.

I understand that the decision of the BES Utilities is final and that there is no appeals procedure.

Date


Please select the box to confirm you agree with the above
Please select what are you applying for:
Date of Meter Read
Meter Read - Evening /       Weekend
Meter Read - Night
Current Electricity

Meter Read - Day
Date of Meter Read
Date of Meter Read
Current Gas
Meter Read

Date of Meter Read
Gas Account Number
Electricity Account Number
Please answer either 'Yes' or 'No' to all questions below by crossing (X) the applicable boxes:
Are you a current BES Utilities Customer?
Have you been a customer of BES Utilities for 12 months or more?
Did you obtain debt advice from Business Debtline before applying to the fund?

Yes

No

Yes

No

Yes

No
Current Gas Debt



Current Electricity Debt

Electricity Arrears £

Gas Arrears £
Business Energy Solutions Fund
Application Form
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Please can you explain the problems which have made it difficult to pay your gas and electricity bills.*
Can you please explain if there are other relevant circumstances within the business or household? For example, any family, work, finances or health such as severe illnesses or bereavement.*
Please tell us how an award from us will help you get back on track with paying your energy bills.*

Business Energy Solutions Fund
Application Form