Rural England Prosperity Fund (REPF) - Capital Grant Claim Form

IMPORTANT - FOR EXPORT GRANT CLAIMS CLICK HERE

READ THIS FIRST - Before You Begin Your Claim

⚠️ Important: The online form must be completed in one session. You cannot save and return later.

To avoid losing any work, please download the offline copy of the form and prepare your responses and evidence before starting.

Before completing your claim:

Read the Rural England Prosperity Fund (REPF) Claim Guidance for full eligibility details.
Ensure all items have been paid for, received, installed and are in working order.
Have digital copies ready of:
- All invoices and bank statements showing payments made
- Any procurement evidence (quotes/tenders, completed Procurement Statement)
- Photos or certificates showing installed assets

Fields marked with * are mandatory.

Need help?

If you have any questions while completing the form, please email grants@teesglobal.co.uk and one of our Grant Claims Officers will assist you.

Project & Organisation Details

GFA Reference (from your Grant Funding Agreement)

Grant Recipient (Business Legal Name)

Trading Name (if different)

Company / Charity No. (or UTR)

Businesses NOT registered with Companies House are required to upload evidence of their UTR.

Please upload evidence of Unique Tax Ref (UTR) number

If your business is NOT registered with COMPANIES HOUSE please upload evidence of a UTR - this can be a screenshot or photo of the part of a formal document showing the UTR no, e.g. from HMRC.

Contact Name

Job Title / Role

Phone Number

Website

Trading Address or Address where the Project Activity took place

Trading Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Registered Address (if different to trading address)

Bank & Finance Details

Business Bank Account Name (must match recipient)

UK Business Bank

IMPORTANT: Grants can be paid into UK business bank account only (in the grant recipient’s name). Virtual or multi-currency accounts are not eligible

Business Bank Account Number

Sort Code

IBAN Number

IBAN Numbers start with GB and are 22 characters long. You can find this on your mobile banking app or your bank statement.

Contact in finance for payment queries - we are required to verify bank details before any monies can be transferred.

Phone (for Finance Contact)

Claim Summary

3.1 Total eligible cost of the project? (exclude the VAT cost if you are VAT registered) (£)

Provide the full cost of your project based on the invoice supplied. This is the total project value, not just the grant request.

3.2 Grant amount claimed (£)

This cannot exceed the maximum grant award offered (£) as outlined in your Grant Funding Agreement

3.3 Private match (i.e. any amount you have paid to balance any wider costs, if applicable) (£)

Itemised Expenditure (defrayed)

4.1 Please itemise the total project cost - that you are claiming - for each item/service (must match approved items detailed on your Grant Funding Agreement (GFA))

Note: Payment can only be made if we can clearly identify items described on the invoices uploaded and these match those approved on your GFA

4.2 Attach copies of all invoices and matching bank statement lines showing payment has left your account. For card payments, include merchant receipts and bank statement lines. Cash payments are not eligible

Please upload evidence, where relevant/required of items, purchases or work undertaken (e.g. photos of installed equipment, refurbishment, before/after, commissioning certificates, etc)

Procurement & Quotes Compliance

5.1 Confirm the procurement route used for each item (as outlined in the Procurement & Quotes Rules in your Claims Pack).

Explain any variances from the approved item list, on the procurement statement (template in claims pack)

5.2 Please upload copies of (1) the completed Procurement Statement (template in claim pack) (2) all quotes/tenders obtained

Please include a short value-for-money justification if a higher-priced supplier was chosen (template in claim pack)

Outputs, Outcomes & Monitoring

Declaration of Outputs/Outcomes Achieved as a Result of REPF Support

6.1 Please specify the number of hours your business considers to be a standard full-time working week (e.g. 37.5 or 40 hours). This information will be used to calculate full-time equivalent (FTE) jobs created or safeguarded.

6.2 I confirm that, as a direct result of the grant funding received under the Tees Valley REPF Rural Support Programme, the following outputs and outcomes have been achieved within our business/organisation:

Jobs Created

Please indicate the Number of Jobs Created as a result of this support

Job '1' Title

Start Date (job 1)

Weekly Hours (job 1)

Job '2' Title

Start Date (Job 2)

Weekly Hours (job 2)

Job '3' Title

Start Date (job 3)

Weekly Hours (job 3)

Job 4 Title

Start Date (job 4)

Weekly Hours (job 4)

Declaration

I declare that:

The job(s) listed above were created as a direct result of the project or investment supported by the grant.
These are new, additional roles and not existing posts re-designated or replaced.
The posts are expected to be sustained for a minimum of 12 months from the start date shown (subject to normal business conditions).

Jobs Safeguarded

Please indicate the number of Jobs Safeguarded as a result of this support

Job Title / Role

Date Job at Risk Identified

Weekly Hours

Reason Job Was at Risk

Please list all Job Titles for the roles that were at Risk, the weekly hours for each role, the date the risk was identified and the reason the jobs were at risk.

I declare that:

The job(s) listed above were at genuine risk of redundancy or loss prior to receiving the grant.
The funding provided through this project directly contributed to safeguarding these post(s), which would otherwise have been lost.
The job(s) are expected to remain in place for a minimum of 12 months following the date of this declaration (subject to normal business conditions).

Engaged in New Markets*

*Engaged means you have launched a product or service into a new market or have undertaken research or attended conferences or events to prepare a launch into a new market. *New market refers to a new product market (i.e. creation of a product/service that doesn't compete or replace previous products produced by the business) or geographic market (i.e. operating in a new area which could be, for example, a new region or country)

Adopted New to the Firm Technologies or Processes*

*A technology or process is new to the firm if it did not use a technology or process with the same functionality before, or the production technology or process is fundamentally different from those already used. This may be tangible or intangible.

Improved Productivity*

*Productivity refers to the gross value added per hour worked or gross value added per worker.

Increased visitor numbers*

*The increase in number of visitor admissions to the local area, including markets, town centre, tourist attractions, green and blue spaces and cultural and heritage venues. The count of attendance should be based on tickets / entry figures, where applicable.

6.3 Please provide details of (and explain why) any outputs/outcomes listed in your GFA were not achieved

If you have not yet achieved an outcome but expect to in the future, please include an estimated date you expect to - so that we can contact you again at that time for confirmation.

Asset Register & Retention

This section only needs completing if individual items purchased with grant funding exceed £1,000 in value or are considered fixed installations.

Please list any equipment or fixed assets purchased using the grant. For each item please include: Asset description - Serial Number - Install location - Date installed

I declare that the asset(s) purchased using the grant will be retained and used for the approved purposes for a minimum of three (3) years from the date of purchase.

Permissions & Compliance

Please complete this section to confirm that all necessary permissions, consents and insurances are in place for your project and any grant-funded assets.

8.1 Planning permission / building regulations

Required for any structural alterations, signage, extensions, or changes of use.

8.2 Landlord consent

Required if your business occupies rented or leased premises and the funded works/equipment are fixed or structural.

I declare that where applicable, all works and installed assets comply with current H&S regulations and are safe to operate; and all necessary/required insurances are in place to cover the installed items.

Declarations

I certify that:

All Outputs and Outcomes reported herein were achieved as a direct result of the project or investment support by the grant. I understand this information may be used as evidence to support UK Shared Prosperity Fund (UKSPF) output reporting and may be verified through monitoring or audit.

All expenditure in this claim has been defrayed, is eligible and matches the items approved in the GFA.

No items in this claim were ordered or paid for before the GFA was signed.

All items have been received, installed and are in working order.

We understand grants are paid in arrears and are subject to audit and clawback if terms are breached.

Information supplied is complete, true and accurate.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Name

Position

Date

Disclaimer: Please note that by submitting this claim form, you are consenting to any personal data collected being processed by Tees Global Ltd and shared with partners involved in the delivery of this programme. This includes the Redcar & Cleveland Council and Tees Valley Combined Authority. The personal data will be held for the purposes of processing grant claims and administering any grant approved.

Rural Claims Guidance Doc

Rural Claim Form PDF

Rural England Prosperity Fund (REPF) - Capital Grant Claim Form

IMPORTANT - FOR EXPORT GRANT CLAIMS CLICK HERE

Project & Organisation Details

Trading Address or Address where the Project Activity took place

Bank & Finance Details

Claim Summary

Itemised Expenditure (defrayed)

Procurement & Quotes Compliance

Outputs, Outcomes & Monitoring

Asset Register & Retention

Permissions & Compliance

Declarations