Covid-19 Impact Report Form

Please use the form below to report to us the impact that Covid-19 is having on your business.

Agreement Name

Agreement Number (if known)

Items Funded *

Primary Contact Name *

Position

Contact Email *

Contact Telephone *

What is the your current trading situation

What actions have you taken to mitigate the impact

Overall financial commitments and any agreed arrangements

What cash reserves, ability to make payments do you have

Details of supporting overdraft levels and utilisation

What action have you taken to access suppport from your bank

Engagment with Crown (PAYE, HMRC, VAT etc)

Support from shareholders or guarantors

What Continuity plan do you have in place (0-3, 3-6 months)

What is your preferred arrangement

Attachment 1

Attachment 1 Description

Attachment 2

Attachment 2 Description

Attachment 3

Attachment 3 Description

Attachment 4

Attachment 4 Description

Do you have a complaint?