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Application 1

Non-Domestic Rates Statement of Financial Entitlements Application

Provider Information

Provider Name
Not provided
Contract Number
Not provided
Provider Address
Not provided
Email Address
test@example.com
Other Addresses
Not provided

Payment Responsibility

Solely Responsible
Yes
No Reimbursement Confirmed
Yes
Fraud Disclosure Consent
Yes

Financial Details

NHS Percentage
75.00%
Council Demand
£5000.00
Bill Payment Method
Monthly instalments
Total Reimbursement Requested
£3750.00
Reimbursement Period
Not provided

SBRR Information

SBRR Claimed
No
Reason Not Claimed
Rateable value exceeds limit

Supporting Information

NHS % (with evidence)
75.00%
Signature
Test Signature
Date Signed
11 July 2025

Submission Details

Submitted Date
11 July 2025 at 02:08
Client IP
::1
Application ID
1
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Warning This application contains personal data. Handle in accordance with GDPR and data protection policies.