Form 1 Application to Enrol

1 – Applying to enrol as an

Environmental Body (an EB)

ENTRUST

60 Holly Walk

Royal Leamington Spa

Warwickshire

CV32 4JE Email:

Fax: 01926 488 388

Tel: 01926 488 300

Please see the guidance note which accompanies this form which is available with the ‘Library’ section at www.entrust.org.uk and offers comprehensive guidance on organisations eligible to enrol. If you have any questions about filling this form in, please contact ENTRUST through the methods above. Please complete in black, using block CAPITALS, and keep a copy for your records.

Basic Details

1) / Name of the organisation. / This is the full legal name of the organisation.
2) / The organisation’s trading name if different from the one above. / You only need to complete this if your trading name is different to the name above.
3) / Company number if applicable.
4) / What is the organisation incorporation type? Please tick one from the following list.
A Chartered Company
A Church
Company with Share Capital
Company with limited by guarantee
A Partnership
A Statutory Body
An Unincorporated Association
Other (please state incorporation type)
5) / The date the organisation was incorporated or established (dd.mm.yyyy e.g 04/04/2004) /
6) / The organisation’s financial year end is (dd). /
The organisation’s financial year end month (mm) /
7) / Is the organisation VAT registered? / Yes / No
If VAT registered its registration number is /
8) / Does the organisation have charitable status? / Yes / No
If a charity, the charity number is
9) / Are you a trust? / Yes / No
10) / Registered Address for this Environmental Body
1) / Address line one
2) / Address line two
3) / Address line three
4) / Town
5) / County
6) / Post Code
11) / Contact Address to which communication to the organisation will be sent, if different to the Registered Address
7) / Address line one
8) / Address line two
9) / Address line three
10) / Town
11) / County
12) / Post Code

Your Governing Document

12) / The organisations must be ‘not for profit’. Does the organisation operate on this basis? / Yes / No / You can not make profits and distribute them to directors or shareholders.
13) / Does the organisation have a document voting procedure within its governing document (if yes, underline in the constitution) / Yes / No / Please ensure there is a clause in your constitution detailing how decisions are made.
14) / Does the organisation have a document dissolution clause within its governing document (if yes, underline in the constitution) / Yes / No / Please ensure your organisation would give any remaining LCF monies upon dissolution to an organisation that is enrolled with ENTRUST.
15) / Does the organisation have a document statement that it will not distribute any profits within its governing document (if yes, underline in the constitution) / Yes / No / You can not make profits and distribute them to directors or shareholders.
16) / Is the organisation owned in whole or in part through a holding company of a Local Authority or Landfill Operator? / Yes / No / A Landfill Operator or a Local Authority can not own your organisation in whole or in part.
17) / Does the organisation’s governing document detail the appointment and removal of directors? / Yes / No / A Landfill Operator or a Local Authority can not appoint or remove directors of the organisation.
18) / Can a Local Authority or Landfill Operator acting on their own form a majority on the board or management committee? / Yes / No / Neither of these parties can form a majority on your board.
19) / According to the organisation’s governing documents, what is the actual number of people required to be present to make a management/board/executives meeting for it to be quorate. (Please enter a number the minimum being 2). / This is the number of people that have to be at a meeting to ensure the meeting is quorate. This figure will be in your governing document.
20) / Please confirm the number of directors/trustees/elders who make up your organisations management committee.

Main Contact Details

ENTRUST is the regulator of the Landfill Communities Fund (LCF) and we are required to collect and process personal data of individuals who have roles within Environmental Bodies. We will only use the personal information provided to us within this form to direct queries and information to the correct person within the Environmental Body. In addition, Paragraph 33(1)(g) of the Landfill Tax Regulations 1996 precludes anyone being involved in the management of the Environmental Body who has controlled or been involved in the management of a previously compulsory revoked Environmental Body. By supplying the personal information below, ENTRUST are able to determine if the organisations and the individual fulfil this requirement. By completing this form, you confirm that all individuals have given their consent to you providing their personal information to ENTRUST for use in accordance with the privacy policy and as otherwise required under the LCF Regulations. We will not share any personal information from this form with any third parties, other than those that have a statutory right of access to information held by ENTRUST pursuant to the LCF, nor will we sell any personal data to any third party organisation. For further information on how we use and secure the personal data provided and your rights of access to the data held, please contact the Data Protection Officer, ENTRUST, 60 Holly Walk, Leamington Spa, Warwickshire, CV32 4JE.

Please confirm you have read the Privacy Policy above.

Details of Main Contact

1) / Title (Mr, Mrs, Ms etc)
2) / Forename*
3) / Surname*
4) / E-mail address
5) / Will this person log on to EOL / Yes / No
6) / Are you a director/board member or trustee of this Environmental Body (if no continue to Director Details sheet)
If yes please complete the details below. / Yes / No
7) / Date of birth (dd/mm/yyyy e.g 04/04/2004)
8) / Telephone number
9) / Home Address line one*
10) / Home Address line two
11) / Home Address line three
12) / Town*
13) / Post Code*
14) / Role in Organisation
15) / Are you an excluded individual? / “An excluded person is someone who: (a) controlled or was concerned in the management of an Environmental Body that was involuntarily revoked; (b) has been convicted of an indictable offence; (c) id disqualified for being a charity trustee or a trustee for a charity; (d) is connected with any of the persons or bodies mentioned above; or (e) is incapable by reason of mental disorder.”
Yes / No
16) / Occupation*
17) / Employer’s name
18) / Serve as a Cllr with a Local Authority / Yes / No
19) / Employed by a Landfill Operator / Yes / No
20) / Does this person have a right to vote in a committee meeting? / Yes / No

Directors/Trustees/Elders Details

Please photocopy this sheet before completion to enable you to submit all your Directors/Trustees information.

Director details are required by ENTRUST and you should list below all current serving Directors or Trustees.

Details of a Director or Trustee

Other Contact

Please complete this sheet for anyone who will require access to EOL for the purpose of updating your details on our online system.

1) / Title (Mr, Mrs, Ms etc)
2) / Forename*
3) / Surname*
4) / E-mail address
1) / Title (Mr, Mrs, Ms etc)
2) / Forename*
3) / Surname*
4) / E-mail address
1) / Title (Mr, Mrs, Ms etc)
2) / Forename*
3) / Surname*
4) / E-mail address
1) / Title (Mr, Mrs, Ms etc)
2) / Forename*
3) / Surname*
4) / E-mail address

Projects

Please select all projects that are applicable to your environmental body. Please note that your organisation is limited to spending landfill tax money on works that are covered by the objects stated in the governing document, and which continue to mirror the objects within the Landfill Tax Regulations.
1) / Object A / To remediate land which is contaminated.
2) / Object B / The remediation of pollution to land or water.
3) / Object D / To provide or maintain a general public amenity.
4) / Object DA / The conservation of Biodiversity at a specific site.
5) / Object E / The restoration of a church or another historic building
6) / Object F / To undertake services for other environmental bodies
Brief summary of types of projects you intend to submit.

Declaration

To the best of my knowledge and belief, the information on this form is true. I am authorised by:

Name of the organisation
to sign this declaration.
Your signature
In Capitals, please:
Your name
Your job title
Date
Checklist
Have you:
Kept a copy of this form for your records?
Included a copy of your constitution with the relevant clauses underlined?
Enclosed a cheque for £100, made payable to ENTRUST, to pay your application fee?
Enclosed your last approved annual accounts?
OR
The organisation is newly formed and we can not include these.

Form 1- Applying to enrol as an environmental body 9 of 9

Version 3 26/04/2012