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Application 11

Non-Domestic Rates Statement of Financial Entitlements Application

Provider Information

Provider Name
Nelson Dentist Practice
Contract Number
120002932
Provider Address
Address
Address
Email Address
plumber@something.net
Other Addresses
test

Payment Responsibility

Solely Responsible
Yes
No Reimbursement Confirmed
Yes
Fraud Disclosure Consent
Yes

Financial Details

NHS Percentage
23.00%
Council Demand
£3256.00
Bill Payment Method
Monthly instalments
Total Reimbursement Requested
£2365.00
Reimbursement Period
14 July 2025

SBRR Information

SBRR Claimed
Yes

Supporting Information

NHS % (with evidence)
Not provided
Signature
3232
Date Signed
Not provided

Submission Details

Submitted Date
13 July 2025 at 00:51
Client IP
86.9.8.227
Application ID
11
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Warning This application contains personal data. Handle in accordance with GDPR and data protection policies.