Household Welfare Application Form

Fill in all the sections to the best of your knowledge to help us give you all the help you need

Are You The Applicant?

YES NO

Title

Mr Mrs Miss

Forename

Other Name

Surname

National Insurance Number

Gender

Date of Birth

Do You Have An Address

Yes No

UK Postcode

Is the request being made for the address where you live?

Yes No

Do you rent your home?

Yes No

Accommodation Type

Applicant's Contact Details (at least one must be provided)

Phone No

Mobile No

Email Address

Preferred Contact Method

Do you have a partner who lives with you?

Yes No

Details of Partner

Do you have any children who live with you?

Yes No

We need to know about any children you (or your partner) have that are: Under 16 Aged 16 or 17 and registered for work or youth training; or Aged 16, 17, 18 or 19 and in education doing a course not higher than GCE A-Level, SCE Higher level or GNVQ (advanced).

Are you or your partner pregnant?

Yes No

Do you have any other adults living with you?

Yes No

Details of Other Adults Living with You

Do you or a member of your family suffer any health issues?

Yes No

Details of the Health Issues

Are you leaving (or have recently left) care or an institution?

What is the name of the care establishment or institution?

Are you seeking help to travel?

Yes No

Reason for Travel

Are you waiting for a grant or loan from another source?

Yes No

Please give details below

Have you applied for or received a budgeting loan/ budgeting advance via the Department of Work and Pension?

Yes No

Please give details below

Are you currently subject to a benefit sanction?

Yes No

Please give details below

Are you part of a planned resettlement scheme?

Yes No

Please give details below

Have you suffered a recent disaster?

Yes No

Please give details below

Document Upload

Is there anything else you wish to add?

Which of the following are you applying for ?

What exceptional circumstances have led you to make this application and what will happen if you do not receive this grant? Please give as much information as possible

LIGHT FOUNDATION

Contacts

Call us

(020) 36 436304

Email

info@lightfoundations.org

Registered Office

Light Foundations
The Lido Centre,
63 Mattock Lane Ealing, London.
W13 9LA

Household Welfare Application Form

LIGHT FOUNDATION

Contacts

Call us

Email

Registered Office

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