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*

Email Address*

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*?

Are you registered disabled?*

Have your financial circumstances changed since your last application?*

Are you in receipt of Universal Credit?*

Do you own your house or any other property and 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?*

Are you in receipt of Personal Independence Payment (PIP)?*

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.

Please give details of your household income.*

Please give details of your State Pension (weekly)?*

Do you receive KCC Care Support?*

Do you receive the Winter Fuel Allowance?*

How much is your Private Pension (if any) per week/month?*

If rented is it private or social housing?*

Do you own any other property?*

Does anyone else living in the property contribute to the rent or mortgage and if so how much?*

Do you have any savings? If so, please provide details of how much together with a copy of the most recent statement for each account.*

Please provide details of any monthly rent or mortgage and any credits received as a contribution towards your rent or mortgage from the Local Authority.

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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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