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* 1. Shop name

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* 2. Shop location

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* 3. Contact details 

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* 4. What is your store size? (Gross)

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* 5. How many employees do you employ (W & PT)

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* 6. How much have you spent on electricity in March 2022? Calculated by reference to unit cost, standing charges and detail the amount of electricity consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 7. How much have you spent on electricity in April 2022? Calculated by reference to unit cost, standing charges and detail the amount of electricity consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 8. How much have you spent on electricity in May 2022? Calculated by reference to unit cost, standing charges and detail the amount of electricity consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 9. How much have you spent on electricity in June 2022? Calculated by reference to unit cost, standing charges and detail the amount of electricity consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 10. How much have you spent on electricity in July 2022? Calculated by reference to unit cost, standing charges and detail the amount of electricity consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 11. How much have you spent on electricity in August 2022? Calculated by reference to unit cost, standing charges and detail the amount of electricity consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 12. How much have you spent on gas in March 2022? Calculated by reference to unit cost, standing charges and detail the amount of gas consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level. Ignore this section if gas prices are not an issue for you - go directly to the next section

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* 13. How much have you spent on gas in April 2022? Calculated by reference to unit cost, standing charges and detail the amount of gas consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 14. How much have you spent on gas in May 2022? Calculated by reference to unit cost, standing charges and detail the amount of gas consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 15. How much have you spent on gas in June 2022? Calculated by reference to unit cost, standing charges and detail the amount of gas consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 16. How much have you spent on gas in July 2022? Calculated by reference to unit cost, standing charges and detail the amount of gas consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 17. How much have you spent on gas in August 2022? Calculated by reference to unit cost, standing charges and detail the amount of gas consumed.  Please put in an amount for each separately - standing charges, usage charge (unit cost), consumption level.

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* 18. If you are eligible for the TBESS – what do you expect will be the shortfall in your energy costs between September and February 2023?

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* 19. How will you manage to address any shortfall in meeting your energy costs over the coming months? (eg; Borrowings, cutbacks in staff, reduction in opening hours, price increases, other?)

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* 20. Will you 

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