Details of contractor premises for which an improvement grant is claimed Section 2 contractor details – 2.1 Is this the main surgery or a branch surgery? Main/Branch What is the current contractor population? 2.2 2.3 Is the contractor dispensing? YES/NO 2.4 What percentage of contractor list size use this site? 2.5 What is the current GMS/PMS/APMS net internal area? (NIA)/gross internal area (GIA) (m2) 2.6 Is freehold of the premises owned by the YES/NO contractor (or partners)? Section 3 Previous improvement funding/grants – 3.1 Have any previous grants or payments been approved in the last two years on these premises? a. Improvement grant Yes / No
Details of contractor premises for which an improvement grant is claimed Section 2 – contractor details 2.1 Is this the main surgery or a branch surgery? Main/Branch 2.2 What is the current contractor population? 2.3 Is the contractor dispensing? YES/NO 2.4 What percentage of contractor list size use this site? 2.5 What is the current GMS/PMS/APMS net internal area? (NIA)/gross internal area (GIA) (m2) 2.6 Is freehold of the premises owned by the YES/NO contractor (or partners)? Section 3 – Previous improvement funding/grants 3.1 Have any previous grants or payments been approved in the last two years on these premises? a. Improvement grant Yes / No
IG%201%20form%20140115%20final.docx