Organisation details Business Rates account number Company/charity registration number Name Name of liable person(s)/company/charity Address details Address of rated premises Address First line of Address Second line of Address City/Town Postcode Date of occupation Contact details Name Customer name Title Title - Select -MissMsMrMrsDrOther… Enter other… First name Last name Correspondence Address (if different from above) Same as above Correspondence address First line of Address Second line of Address City/Town Postcode Contact Email Phone number Business details Interest in property Owner Leaseholder Tenant Under license Occupier Other… Enter other… Date of completion of purchase Owner details Name Owner Name Address Owner address Address Address 2 City/Town Post Code Contact details Owner email address Owner telephone number Additional details Date of completion of purchase/lease or tenancy Is this the only business premises that you pay business rates for in England or Wales? Yes No If applicable would you like to apply for Small Business Rate Relief? Yes No Will the premises be predominantly for retail use? Yes No Type of retail use. E.G. Clothes shop, café SIC details Are you registered with Companies House? Yes No Status message Please check the Government SIC information page and enter the code that closest resembles your business type Business SIC code Person completing this form Your name First name Last name Relationship to business 14897
