RSF application form

REFUGEE SUPPORT FUND APPLICATION

To make an application, please complete and submit the form below. Or you can download a copy and post it to:
Elmbridge CAN, PO Box 112, East Molesey, KT8 8EN. Please contact us if you would like a copy of this form in Arabic.

Please ensure you complete ALL sections marked with a * or the form will not submit.

BENEFICIARY'S DETAILS

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email address *

Phone Number *

Date of arrival into the UK *

BRP/ARC number or ID document number *

Refugee status (tick as applicable) *

Granted Pending

ABOUT THE GRANT

How much are you applying for? *

Please explain what the grant is for - include links to items/websites if possible or an estimate of cost for each item *

How do you think this grant will make a difference to the beneficiary's life? *

Please use this space to provide any other information you think is relevant to help us to assess your application *

How and when will Elmbridge CAN be provided with a receipt for the expenditure enabled by this grant? *

PAYMENT DETAILS

We will only request bank payment details if and when this application is successful.

Please advise if the beneficiary is under 18? *

Yes No

If YES, please note the funds will be paid either to the young person’s support worker; the foster parent(s); or direct to the service provider eg, if for sports club or residential camps, and it will be their responsibility to ensure the money is spent in accordance with this application.

REFERER / SPONSOR DETAILS

If you are applying on behalf of someone else, please provide your details below.

Name *

First

Last

Organisation & job title (if applicable) *

What is your relationship to the applicant? *

Email *

Phone Number *

DECLARATION

I confirm that the above information is correct to the best of my knowledge and belief. *

Yes No

PAYMENT & AUTHORISATION (Please do not complete this section)

Payment details (FOR OFFICE USE ONLY)
Account Name: _____________
Bank Name:_______________
Sort Code: ________________
Account Number:____________

Elmbridge CAN Authorisation (FOR OFFICE USE ONLY)
First Authoriser: ____________
Second Authoriser:___________

Submit

Elmbridge CAN collects personal information when you subscribe for updates, submit a funding application or other enquiry. We will use this information to provide the service(s) requested, maintain internal records and, if you agree, to send you updates about our work and projects or appeals we think might interest you. We will never share your personal information with third parties unless we have your permission to do so or are required by law to do so. For more information explaining how we use your information, please see our Privacy Policy.

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REFUGEE SUPPORT FUND APPLICATION

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