Please only complete the application form if you have followed the 4-step process illustrated above and think you are eligible for the scheme.

Please complete the application form clearly and ensure all sections are completed. This will help to prevent delays in processing and payment of your claim. Please send your completed form to Listed Places of Worship Grant Scheme, PO Box 609, Newport, South Wales NP10 8QD.

If you require any assistance, then please speak to one of our operators on 0845 601 5945. This will be charged as a local call.

Section 1: Contact Details	Instructions
1. Name/dedication of the listed place of worship	Please provide the full name of the listed place of worship to which the application relates.
2. Address of the listed place of worship.	Please provide the address of the listed place of worship to which the application relates. Please note County must be completed in all cases.
3. Name of local authority / council in whose area the place of worship is located.	Please provide the name of the local authority or council in which the place of worship is located. In Wales and Scotland this will be the Unitary Council. In Northern Ireland this will be the District Council. In England this will either be the London Borough, the Metropolitan Borough, the District Council or the Unitary Council.
4. Religion or denomination.	Please provide the religion and/or denomination served by the place of worship.
5. Name of person/organisation with legal responsibility for the works to which the application relates.	This may be you or it may be another body.
6. Details of countersignatory.	This must be an individual who holds a suitably responsible position in the body that has legal responsibility for the place of worship, e.g. a priest, minister etc.
7. Correspondent details.	Please provide the name of whoever would be best placed to deal with queries, should the need arise. You should also be aware that this individual will also receive all correspondence (incl. Payment remittance and returned invoices).
Section 2: Place of Worship	Instructions
8.	See Step 1 in the guidance notes
9.	See Step 1 in the guidance notes
10.	See Step 1 in the guidance notes
11.	See Step 1 in the guidance notes
Section 3: Listed Building	Instructions
12.	See Step 2 in the guidance notes
13. Listing grade or category:	Listed buildings have a number of grades or categories. Please provide the listing grade or category if you know it.
Section 4: Eligible Expenditure	Instructions
14.	See Step 3 in the guidance notes
15. Description of the works	Please note we will need to verify that the works relate to the fabric of the building as explained in Step 3 of the guidance notes. You should ensure the supporting documentation you enclose enables us to do this.
16.	See Step 3 in the guidance notes
17.	See Step 3 in the guidance notes
18. Effective net rate of VAT	We will need to see evidence of an agreed rate of VAT with HM Revenue and Customs. This will normally be in the form of a letter from HM Revenue and Customs and should be enclosed with your application.
19.	As above
20.	See Step 3 in the guidance notes
Section 5: Your claim Examples of claims for eligible works are shown below:
The works within the invoice are fully eligible: Inv Ref Net Amount (1) VAT Rate (2) % Eligible Works Reclaimed (3) Total Amount of Grant Claimed (4) ABC123 £150.00 20% 100% £30.00 (1) - Eligible invoice amount before VAT is added. (2) - The actual VAT rate charged (in the majority of cases, this will be 20%) (3) - The amount of work on the invoice you consider eligible. (Above example is fully eligible so this is 100%. Example below is only partially eligible, so this shows a reduced percentage.) (4) - The money you are requesting from the grant scheme in respect of the specified invoice.
The works within the invoice are only partly eligible: Inv Ref Net Amount (1) VAT Rate (2) % Eligible Works Reclaimed (3) Total Amount of Grant Claimed (4) ABC123 £150.00 20% 75% £22.50 The minimum amount you can claim in a single application is the VAT incurred on eligible works costing £1,000. If you have not undertaken works to this value, please keep all your documentation and submit the application when you have the additional eligible invoices, which will bring the amount claimed to the required minimum amount.
Section 6: Your payment details
Payments will only be made to bank/building society accounts authorised for official use by the place of worship to which the application relates
Section 7: Declaration
This should be signed and countersigned by two separate, authorised individuals in the organisation that has legal responsibility for the place of worship. For example, the signatory might be the Treasurer, and the countersignatory might be the priest or minister. The countersignatory should hold a more senior position.