Please note that an application to any of the above Trusts is an application to them all.

PLEASE READ THE GUIDELINES BEFORE COMPLETING THIS FORM AS ANY INCOMPLETE FORMS WILL BE REJECTED

Applicant's address:
Applicant Postcode:
Applicant Tel no.:

Items requested (please prioritise items):
1st choice: Amount: (£)
2nd choice: Amount: (£)

Is the property a Socially Rented/Private Landlord/Other (please specify):
Landlords name:

Please list all members of the family who live at the same address:
Type
Name
DOB
Occupation/School








Is the applicant a legal resident in the UK?:
If no current status:

Background / brief history:

Current circumstances:

Help requested:

The impact this help will have:

Wider support in place:

Your organisation and role:

Family's Finances Form

PLEASE MAKE SURE THAT THIS SECTION IS COMPLETED ACCURATELY AS TRUSTEES

REVIEW THIS AS PART OF THEIR DECISION-MAKING PROCESS
The figures below must be based on the monthly income and expenditure and contain totals. If this is not
completed correctly then the application will be rejected
Any surplus in funds requires an explanation.

Family's household finances
Income (£)
Expenditure (£)

Net Salary: Rent / mortgage:
Partner’s Net Salary: Ground rent / service charge:
Maintenance – Child Support: Council Tax:
Universal Credit: House insurance:
Housing Benefit: Water rates:
Council Tax Benefit: Gas:
Income Support - net of deductions: Electricity:
Employment & Support Allowance: Telephones (home & mobiles):
Working Tax Credit: TV licence (inc. cable):
Child Tax Credit: Internet:
Child Benefit: Food & household:
DLA / PIP (mobility): Car costs (fuel, tax, insur & loan):
DLA (care) / PIP (daily living): Public transport costs:
Carer’s Allowance: Hire purchase repayments:
Attendance Allowance: Catalogue & club repayments:
State Retirement Pension: Bank loan & overdrafts:
Pension credit: Credit & store card repayments:
Debts - Monthly amounts
Rent / mortgage:
Council Tax: Water: Telephones: Electricity:
Gas:
HP repayments:
Social Fund loan:



Total income: Total expenditure:

Explanation of surplus or deficit of funds:

Recent family welfare benefits check:


Debts
Total Outstanding

Rent / mortgage:
Council Tax:
Water:
Telephones:
Electricity:
Gas:
HP repayments:
Social Fund loan:



Total debt:

Details of other applications for these items
(E.g. application to the local education authority or other charities, etc. Specify amount requested and outcome)
1:
2:
3:

Sponsor's contact details
First Name:
Last Name:

Address:
Tel no.:
Signature: