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BACKGROUND INFORMATION

You are applying to be considered for Cohort 21, starting September 2024.

Application Closing Date:
29 April 2024

Interviews:
Week Commencing 20 May 2024

Final Decision:
22 July 2024

You are able to save your application at the top of the page and resume later.

1. Preferred first name(s) (as you would like to be known on the course)

2. Preferred surname (as you would like to be known on the course)

3. Legal first name(s)

4. Legal surname

5. Email

6. Work phone

7. Mobile

8. Gender

MaleFemaleI use another term (for example non-binary) - please describe Prefer not to say

8a. Please enter your gender identity

9. Please select your ethnicity

White British (including white English, Scottish, Welsh or Northern Irish)White IrishAny other White background – please specifyMixed White and Black CaribbeanMixed White and Black AfricanMixed White and AsianAny other mixed background – please specifyIndianPakistaniBangladeshiChineseAny other Asian background – please specifyBlack CaribbeanBlack AfricanAny other Black background – please specifyArabAny other ethnic group – please specify

9a. Please further specify your ethnicity

10. Please select your sexual orientation

HeterosexualGay/LesbianBisexualI use another term (for example queer) - please describe Prefer not to say

10a. Please further describe your sexual orientation

11. Do you consider yourself to have a disability

Yes - if you feel comfortable, please could you describe (optional)NoPrefer not to say

11a. Please further describe your disability

I have read and agree to the terms of participation and data protection clauses and privacy policy

Yes

AUTHORISATION FOR BACKGROUND CHECK AND OTHER PERSONAL DATA PROCESSING FOR THE 10,000 SMALL BUSINESSES PROGRAMME

Goldman Sachs International (“GSI”) operates the Programme along with the other Programme Providers (as defined in the Programme Expectations available here) in order to identify suitable high-growth small businesses and social enterprises to provide with high-quality, practical education and business support within the UK. As part of the assessment process for the Programme, the Programme Providers need to understand the identity and the background of those involved with these small businesses and social enterprises.

As a result, GSI requests your consent to the completion of the background verification and screening process described below and your consent to the results of such process and any other information relating to criminal convictions or offences that you provide to us during the application being shared with and used by the Programme Providers for the purposes of your application to the Programme.

Processing information relating to criminal records, including carrying out the background verification and screening process, is necessary to satisfy the Programme Providers as to your suitability for selection and participation in the Programme and to help protect the Programme Providers against potential reputational, legal and economic risks. GSI will process the data collected in connection with the Programme. GSI will procure that the Programme Providers also process your personal data for this purpose, including in order to process your application and to make decisions with respect to the Programme.

In particular:

You will be asked a number of questions relating to your background as part of the application process. This will include questions relating to criminal convictions and offences. These responses will be managed in accordance with the Data Protection Notice shared with you.
In order to complete the background verification and screening process, GSI instructs a third party supplier, to assist the Programme Providers with the background verification and screening process. This process involves carrying out checks to verify the identity of you (the applicant) and other relevant parties. These include checks relating to these parties':

Credit and solvency history
Criminal background and record
Regulatory sanctions
Directorships
Media profile

If you consent to these checks, you will be required to complete an Application Form (including, without limitation, in the Section entitled “Other Information About You and the Business”). This will be passed to the third party supplier to complete the checks. To undertake the checks, the third party supplier will connect with the relevant governmental agency, which will involve the disclosure of your personal data to that agency. The results of the checks will be provided to the third party supplier and only made available to GSI or the Programme Providers to the extent permitted by law. During the process, your personal data information will be managed in accordance with the Data Protection Notice.

You should provide information that is complete, accurate and true. The provision of misleading, false or inaccurate information, or the omission of material facts, may result in the withdrawal or termination of your selection and participation in the Programme.

If you provide your consent to this processing, you have the right to withdraw such consent at any time. Please see the Data Protection Notice for further information.

Please check the boxes below to indicate whether you provide your consent to this processing activity:

I consent to GSI carrying out the background verification and screening process described above, including partnering with our third party supplier.

I consent to the results of the background verification and screening process being processed by GSI and the Programme Providers as set out above.

I consent to any information relating to criminal convictions or offences that I provide to the GSI or to the Programme Providers during the application being processed by GSI and the other Programme Providers as set out above.

YOUR BUSINESS

12. Business's trading name

13. Business's legal name (if different)

14. Company number

15. Are you VAT registered?

YesNo

15a. VAT number

What is your VAT number

16. Business's legal status

Private Ltd. Company, limited by sharesSole proprietorshipPartnershipPrivate company, limited by guaranteeLimited liability partnerPublic limited companyCommunity Interest CompanyOther, please specify

16a. What is your percentage stake in the business (if the business is limited by shares)?

16b. Please specify the business's legal status

17. Business address

Number/Name

Street

City

Postcode

Region

18. Is this your registered address?

YesNo

18a. What is your registered address?

Number/Name

Street

City

County

Postcode

19. Business's website address

20. Please state your position/title in the business.

21. Is the business family-owned (i.e. jointly owned by you and one or more family members)?

YesNo

22. Please explain what your business does

23. Please select the category that best describes your business's industry sector.

24. Is your business B2B, B2C, B2G or a combination?

B2BB2CB2G

25. Does your business trade with or operate in other countries?

YesNo

25b. Please list the countries that you operate in or trade with.

26. In which year was the business founded?

27. Did you found the business?

YesNo

28. In which year did you become the owner (or co-owner) and/or the most senior decision-maker?

29. What is the business’s financial year end date (DD/MM)?

Please state the turnover, gross profit and net profit of the business for the past two completed financial years and your forecast for the current financial year.

This year (Forecast)	Last financial year	Previous financial year
Turnover £ Please enter full number without decimal places. i.e. 1 million is written as 1000000	Turnover £ Please enter full number without decimal places. i.e. 1 million is written as 1000000	Turnover £ Please enter full number without decimal places. i.e. 1 million is written as 1000000
Gross Profit £ Please enter full number without decimal places. i.e. 1 million is written as 1000000	Gross Profit £ Please enter full number without decimal places. i.e. 1 million is written as 1000000	Gross Profit £ Please enter full number without decimal places. i.e. 1 million is written as 1000000
Net Profit £ Please enter full number without decimal places. i.e. 1 million is written as 1000000	Net Profit £ Please enter full number without decimal places. i.e. 1 million is written as 1000000	Net Profit £ Please enter full number without decimal places. i.e. 1 million is written as 1000000

Please state how many people the business employs today and at the end of the business’s past two completed financial years.

Please enter a full time equivalent (FTE) value rather than the actual number of people.

Today

employees

Last financial year

employees

Previous financial year

employees

30. Please describe why you would like to participate in the 10,000 Small Businesses programme, and how you think it will help you to grow the business.

YOUR CUSTOMERS, COMPETITORS AND GROWTH OPPORTUNITIES

31. Which of the following are your customers? Please select all that apply.

ConsumersCentral governmentCharities and Non-Profit OrganisationsSmall to medium-sized businessesOther public sector (e.g. education or health establishments)Large businessesLocal governmentOther, please specify

31a. Please provide a list of the other types of customer.

32. Do any of your customers account for 50% or more of your revenues?

YesNo

32a. Please provide the approximate percentage of revenues accounted for by this customer.

33. What proportion of your revenues are accounted for by public sector clients? What are the prospects for your business’s revenues from public sector clients in the future?

34. Who are the business's key competitors?

35. What is your unique selling point? Why do your customers buy products/services from your business rather than from your competitors?

36. What are the three main growth opportunities that you plan to pursue in the next three to five years? Please expand upon your objectives.

37. What turnover do you aim for the business to have in five years’ time? What number of employees will the business require to achieve this level of turnover?

38. Please identify and describe the three main factors or challenges that currently limit the growth of the business.

39. Which of the following programmes, resources or networks have you accessed for support or advice?

Business/industry associations (e.g. Chamber of Commerce)Government programmes (e.g. Growth Accelerator, Business Growth Service)AccountantFormal or informal mentors (e.g. colleagues, friends, family)Other, please specify

39a. Please list any other programmes, resources or networks you have accessed for support or advice.

40. How do you currently finance the business? Please select all that apply.

Bank overdraftBank loanMortgage on commercial propertyLeasing or hire purchaseCredit card financeOther, please specify

40a. Please specify other ways you finance the business.

41. Have you taken out any government or council backed Covid-related loans?

YesNo

41a. Please state whether you are up-to-date with repayments and how much of the loan is left to be repaid.

42. What was your inspiration for founding, buying or starting to run the business?

43. Please describe your key business achievements/milestones over the last three years.

44. Is your business a social enterprise?

YesNo

44a. Please explain how you have a social impact.

44b. Does your company offer apprenticeships?

YesNo

44c. Is your company a certified B Corporation?

YesNo

44d. Is your business veteran owned?

YesNo

45. How did you hear about the 10,000 Small Businesses programme?

46. Please use this space for any other information relevant to your application that you would like to provide.

YOUR BUSINESS BACKGROUND

47. All current business interests

Please list all business interests.

Please list ALL your CURRENT business interests where you are a director/senior officer/significant shareholder (10% or more)/proprietor/trustee or have any other major role, including affiliates of the business which are registered as separate entities.

Company

Role

Shareholding

Company

Role

Shareholding

Company

Role

Shareholding

48. All former business interests

Please list ALL your FORMER business interests where you were a director/senior officer/significant shareholder (10% or more)/proprietor/trustee or have had any other major role, including affiliates of the business registered as separate entities.

Company

Role

Shareholding

Date ended

Company

Role

Shareholding

Date ended

Company

Role

Shareholding

Date ended

49. Have you ever been a director/senior officer/significant shareholder (10% or greater interest) of a company/other entity, which became insolvent or entered into any agreement in favour of creditors, either while you were a director/senior officer/significant shareholder or, to your knowledge, within three years of you ceasing to be a director/senior officer/significant shareholder?

YesNo

49a. Please provide details:

PERSONAL INFORMATION

50. What is the highest level of education you have completed?

ADDITIONAL INFORMATION ABOUT YOU

51. Have you any criminal convictions for any offences which are not spent under the Rehabilitation of Offenders Act 1974 (excluding minor traffic offences such as minor speeding or parking offences)?

YesNo

51a. Please provide details:

52. Are you currently engaged in, or the subject of, any criminal proceedings or charges or civil proceedings or arbitration (other than as an expert witness)?

YesNo

52a. Please provide details:

53. Are there any court judgements (satisfied or unsatisfied) or debt recovery actions (e.g. for the failure to pay debts, taxes, etc.) in any country against you, or against (i) any company/other entity of which you are currently a director/senior officer/significant shareholder (10% or greater interest), or (ii) to your knowledge, any company/other entity of which within the last three years, you have been a director senior officer/significant shareholder?

YesNo

53a. Please provide details:

54. Have you ever entered into an Individual Voluntary Arrangement or other agreement in favour of creditors?

YesNo

54a. Please provide details:

55. Have you ever been subject to penalties for deliberate tax evasion?

YesNo

55a. Please provide details:

56. Are you currently the subject of; a. Bankruptcy proceedings or proceedings for the sequestration of your estate or are you aware of any such proceedings pending and/or b. An investigation or any disciplinary procedures?

YesNo

56a. Please provide details:

57. Please list any handles you have or how you are known on the following platforms: Facebook

The name you are known by on Facebook

Instagram

@yourusername

Twitter

@yourtwitterhandle

Do you have a Linkedin account?

YesNo

The web address for your Linkedin page.

ADDITIONAL INFORMATION ABOUT THE BUSINESS

Please note that answering "Yes" will not necessarily disqualify you from participating in the Programme.

58. Has the Business’s legal status (i.e. sole proprietorship, partnership, company, etc.) changed in the last 5 years?

YesNo

58a. Please provide details:

59. During the past five years, has the business been convicted, been the subject of proceedings, or otherwise been charged with a crime or regulatory violation, or fined or censured?

YesNo

59a. Please provide details:

60. Has the business ever been named as a co-conspirator in a criminal complaint or proceeding?

YesNo

60a. Please provide details:

61. During the past five years, has the business been the target or subject of any investigation by a government agency?

YesNo

61a. Please provide details:

62. Do you work with vulnerable groups (i.e. children, the elderly)?

YesNo

62a. Please provide details

Professional licences

62. Does the Business require any professional licences in order to carry on its business lawfully?

YesNo

Licence

Issuer

Is in good standing

YesNo

If not, please explain why

Licence

Issuer

Is in good standing

YesNo

If not, please explain why

Licence

Issuer

Is in good standing

YesNo

If not, please explain why

DIRECTORS, OFFICERS, PRINCIPALS, PARTNERS AND OWNERS OF THE BUSINESS

63. Please list the names, positions/titles and the shareholdings (or other interest) of all major stakeholders, and tick ONE box to indicate the key decision maker (KDM) within the business.

Name

Position/title

% Shareholding

KDM?

Name

Position/title

% Shareholding

KDM?

Name

Position/title

% Shareholding

KDM?

Name

Position/title

% Shareholding

KDM?

Others

Before you complete the final steps, please ensure you have filled in all aspects of the form as failing to do so may lead to your application being rejected.

PLEASE UPLOAD THE FOLLOWING DOCUMENTS

Many small firms file abbreviated accounts at Companies House, containing only a balance sheet and notes to the accounts. The following questions do NOT refer to abbreviated accounts.

Please provide the last two years worth of complete sets of full statutory accounts. The accounts your accountant files at Companies House may be abridged, but they will have a copy of your full accounts; we need to see these full accounts, which will include your turnover, profit and loss and notes to the account.

To see a sample set of full statutory accounts, please click here.

Files larger than 5MB cannot be uploaded. Please do not upload zipped files.

64. Full annual statutory accounts, produced by your accountant, which must include turnover and profit and loss, for the most recent financial year available (PDF only)

65. Full annual statutory accounts for the previous financial year, including turnover and profit and loss (PDF only)

66. Do you keep Management Accounts?

YesNo

66a. Management accounts that cover the period since the end of your last full statutory accounts (PDF or Excel only)

67. Most recent copy of your CV or a short business biography (PDF only)

68. Verification of business as a legal entity (PDF only)

Please provide one of the following:
a. Certificate of incorporation
b. Certificate of trade
c. Certificate of good standing
d. Extract from a company register
e. Trust deed
f. Partnership agreement

69. Additional documents (if you would like to send more than one supporting document, for example if your company has a group structure and we'd need to see accounts of all companies in the group, please click 'Add another response' to the right) (PDF or Excel only)

70. Agreement to terms of participation in the Programme

AgreeDisagree

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Edit Form Title

BACKGROUND INFORMATION

You are applying to be considered for Cohort 21, starting September 2024.

You are able to save your application at the top of the page and resume later.

AUTHORISATION FOR BACKGROUND CHECK AND OTHER PERSONAL DATA PROCESSING FOR THE 10,000 SMALL BUSINESSES PROGRAMME

YOUR BUSINESS

17. Business address

This year (Forecast)

Last financial year

Previous financial year

YOUR CUSTOMERS, COMPETITORS AND GROWTH OPPORTUNITIES

36. What are the three main growth opportunities that you plan to pursue in the next three to five years? Please expand upon your objectives.

38. Please identify and describe the three main factors or challenges that currently limit the growth of the business.

YOUR BUSINESS BACKGROUND

PERSONAL INFORMATION

ADDITIONAL INFORMATION ABOUT YOU

ADDITIONAL INFORMATION ABOUT THE BUSINESS

Professional licences

DIRECTORS, OFFICERS, PRINCIPALS, PARTNERS AND OWNERS OF THE BUSINESS

PLEASE UPLOAD THE FOLLOWING DOCUMENTS