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Application 13

Non-Domestic Rates Statement of Financial Entitlements Application

Provider Information

Provider Name
Nelson Dentist Practice
Contract Number
120002932
Provider Address
street 1
Email Address
plumber@something.net
Other Addresses
Not provided

Payment Responsibility

Solely Responsible
Yes
No Reimbursement Confirmed
Yes
Fraud Disclosure Consent
Yes

Financial Details

NHS Percentage
Not provided
Council Demand
£6547.98
Bill Payment Method
Monthly instalments
Total Reimbursement Requested
£253.96
Reimbursement Period
08 July 2025

SBRR Information

SBRR Claimed
Yes

Supporting Information

NHS % (with evidence)
5.80%
Signature
3232
Date Signed
16 July 2025

Submission Details

Submitted Date
14 July 2025 at 00:56
Client IP
86.9.8.227
Application ID
13
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Warning This application contains personal data. Handle in accordance with GDPR and data protection policies.