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Introduction
Has your business been affected by the recent Coronavirus.
Impact Assessment
What do you estimate the loss of turnover to be?
What do you estimate the damage to your property and stock to be?
Provide a brief description of the damage
Type a value
Any comments regarding your impact
Type a value
Are you insured?
Please Provide Details
e.g. yes for damage to property but not for loss o
How many people Work in your Business (including yourself)?
How many people are currently out of work (including yourself)?
Business Details
Business Name
*
Street Address of your business: Line 1
*
Street Address of your business: Line 2
Town
*
Please start typing
State
*
Postcode
*
Business Contact: First Name
*
Business Contact: Last Name
*
Business email (we will email you with relevant updates regarding recovery services)
*
Confirm Email Address
*
Business Contact Phone Number
ABN
Choose your Industry
Are you a small business (employ under 19 staff)?
Submission
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Please verify that you are not a robot.
Thank You
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