Disability/Hardship Application

Disability / hardship grant application

Note

The William Barrow's Charity in Sittingbourne only provides grants to persons resident within the Parochial Parish of Borden in need, hardship or distress, the priority given to those aged 60 years or more. If in doubt about the extent of the parish, please refer to the "How to Qualify" area of the website.

Disability / hardship Grant Application

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Full Name*

Date of Birth*

Postcode*

Home address at Borden*

Telephone Number at home*

Mobile Telephone Number*

Marital Status

If married, Date of Birth of partner

Family dependants, their names and ages*

Time of residence within the parish*

Occupation/Employment - if retired, state retired*

What is your state of health*?

Have your financial circumstances changed since your last application?*

Please give details of:* i) Weekly Earnings ii) State Pension Amount iii) Other income (ie, pension or benefits)

i) Do you own your house or any other property?* ii) Does anyone in the house contribute to rent?

Do you have any other income such as bank account interest, national savings? If so, please give details.*

Please give details of:* i) Any rent or mortgage paid ii) Amount of council tax paid

Reasons for your application for a grant*

If you wish payment to be made direct into your bank, please provide your account name, account number, and sort code.

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On receipt of this completed form it will be passed on to the Trustee responsible for grant applications, who may wish to make further enquiries. All applications will be treated in confidence.

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