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Welfare Charity Application Form

Please read these terms and conditions before completing your application form.

Data Protection

This Charity aims to fulfil its obligations under the Data Protection Act 1989 to the fullest extent. The Charity is required to process relevant personal data regarding applications as part of their operation and shall take all reasonable steps to do so in accordance with its Data Protection Policy and all relevant associated legislation.

Welfare Charity Application Form Charity No: 237218

Name of Applicant *

Address *

Phone *

Mobile Phone No

Email Address *

Date of Birth *

If applying on behalf of someone else, please give details below

Name of person completing the form if not the applicant

Relationship to applicant

Are you or anyone else directly associated with this claim, a near relative of, or have a close personal relationship with any Trustee or employee of this Charity? *

If yes please give details. Please note that answering yes does not automatically preclude consideration but under Charity Commission rules it must be declared.

What are you asking for Help with? Please support the following, including as much information as possible to support your application as possible including quotes or supplier details.

Item (Please include the breakdown of the total cost being claimed) *

Have you applied for financial assistance in respect of the above from any other source? Please detail below: *

Declaration - I declare to the best of my knowledge and belief that the details submitted are true and correct.

Signature *

Date *