Application for Charitable Payment

Qualification Of Pensioners

Pensioners shall be persons in need who from age, accident or infirmity are wholly or in part unable to maintain themselves by their own exertions and who are resident in the Benefit Area and have been continually resident for the last ten years. This will also be subject to availability of our funds.

Details about yourself

Title - Mr, Mrs, Miss or Ms
MrMrsMissMs

Surname

First Name

Marital Status

Date of Birth

Telephone Number

Email Address

Time Lived In Parish of Bourne

Details about your Spouse/Partner

Title - Mr, Mrs, Miss or Ms
MrMrsMissMs

Surname

First Name

Marital Status

Date of Birth

Time Lived In Parish of Bourne

Address

Are you the householder?
YOU
HomeownerTenant

SPOUSE/PARTNER
HomeownerTenant

Are you responsible for paying any rent and/or Council Tax for the place where you live?
YOU
YesNo

SPOUSE/PARTNER
YesNo

Do you have a mortgage/loan/rent on your home?
YOU
YesNo

Please state weekly payment

SPOUSE/PARTNER
YesNo

Please state weekly payment

Are you in full or part -time employment?
YOU
YesNo

Please state average take-home pay per week

SPOUSE/PARTNER
YesNo

Please state average take-home pay per week

Amount of State Pension received per week

Amount of ALL benefits such a Housing Benefit, Council Tax Benefit, Universal Credit, Pension Tax Credit, Guarantee Credit or Income Support

Amount of any private pensions per week

Income received from land or property per week

Income received from investments per week

TOTAL WEEKLY INCOME

Do YOU have any money, including savings and investments?
YesNo

Please state the amount held in the following:
Bank Current Accounts

Other Bank Accounts

Post Office Accounts

National Savings Certificates

Premium Bonds

Income Bonds or Capital Bonds

Unit Trusts, ISAs or similar investments

Shares - Approximate Value

Any other money or investments - in this country or abroad

TOTAL SAVINGS AND INVESTMENTS

Does your SPOUSE/PARTNER have any money, including savings and investments?
YesNo

Please state the amount held in the following:
Bank Current Accounts

Other Bank Accounts

Post Office Accounts

National Savings Certificates

Premium Bonds

Income Bonds or Capital Bonds

Unit Trusts, ISAs or similar investments

Shares - Approximate Value

Any other money or investments - in this country or abroad

TOTAL SAVINGS AND INVESTMENTS

Signature of Applicant

YOUR APPLICATION WILL NOT BE CONSIDERED UNLESS ALL QUESTIONS ARE ANSWERED IN FULL BY THE APPLICANT AND SPOUSE/PARTNER (IF APPLICABLE)

Please be aware that BUC may need to verify financial information and to make further enquiries about your situation in order to support your application. BUC has a duty to ensure the security of personal data. We will protect the information from unauthorised access, loss, manipulation,
falsification, destruction or unauthorised disclosure.

We will keep your data only for the purpose for which it was collected and only for as long as it is necessary, after which time it will be deleted. For the full GDPR policy please refer to our website www.bourneunitedcharities.co.uk or email: admin@bourneunitedcharities.co.uk