Total 15. Project income Income source (name of organisation) Value VAT Funding Identify all confirmed income and all sources of (excluding vat) confirmed? £ funding applied for extra rows as £ Y/N –add necessary Amount of funding applied for from Conservation Board Total 16. Is there potential for the project to generate income? If yes, please provide further Yes/No details. 17. Permissions required? What, if any, permissions are needed and are they in place? 18. Your Organisation Registered charity Parish council □ □ (tick those which apply) Voluntary Private individual □ □ Private company □ 19. Bank Account -please supply details for grant payment should your application be successful. Declaration: I declare that all the information provided in this application is true to the best of my knowledge. I understand that any misleading statements whether deliberate or accidental could make the application invalid and therefore liable for the return of any money. NAME (PRINTED): SIGNATURE: DATE:
Total 15. Project income Income source (name of organisation) Identify all confirmed income and all sources of funding applied for –add extra rows as necessary Value (excluding vat) £ VAT £ Funding confirmed? Y/N Amount of funding applied for from Conservation Board Total 16. Is there potential for the project to generate income? If yes, please provide further details. Yes/No 17. Permissions required? What, if any, permissions are needed and are they in place? 18. Your Organisation (tick those which apply) □ Registered charity □ Parish council □ Voluntary □ Private individual □ Private company 19. Bank Account -please supply details for grant payment should your application be successful. Declaration: I declare that all the information provided in this application is true to the best of my knowledge. I understand that any misleading statements whether deliberate or accidental could make the application invalid and therefore liable for the return of any money. NAME (PRINTED): SIGNATURE: DATE:
special_projects_application_form_2016.docx