Please read the following important information before filling in the form Eligibility Trainee professional footballers; young persons registered with professional football academies associated with a club or centres of excellence associated with a club wishing to pursue a career as a professional footballer; former trainee professional footballers; professional footballers and former professional footballers. In all cases in this definition persons shall play or have played or trained with a club in the English Premier League and or Football League. Completing the form Please answer every question. You must also sign the declaration and provide photo identification; this can be in the form of a photocard driving licence or passport and a copy of an official letter confirming your address. Having your payslip, bank statement and bills to hand will assist when completing the form. What help can I ask for? Beneficiaries of The Players Foundation have access via the Charity to, where appropriate, financial award payments in the form of a grant and non-financial benefits, which currently comprise of benefits and insolvency advice and neurodegenerative disease assessment to include situational support and guidance. Our team may refer you to one or more of these services once your completed application has been received. Non-financial support is not subject to any assessment of assets. Debt & Welfare Rights Advice There are many organisations that offer free and impartial debt and Welfare Rights advice. You can also obtain this advice via The Players Foundation. If you are facing mounting debts, don’t panic. There are solutions and remedies that can help your situation. The Players Foundation has an independent advisor we can put you in touch with to help you take back control of your situation, talk through possible solutions, and support you in taking action to reduce your debts. If you are in need of a benefits assessment our advisor can carry this out and support, you in making the relevant applications. Financial Hardship: For the benefit of the beneficiaries and their dependents who are in conditions of need, severe hardship and distress and find themselves in necessitous circumstances. We define hardship as the possibility of losing one’s home due to mortgage or rent arrears, having bailiffs sent in or other equally serious financial problems. We may also help with costs associated with resolving debt difficulties e.g., bankruptcy fees, debt relief order. We are not able to make loans to beneficiaries and we cannot pay for: private medical insurance premiums or treatment, any money to help set up or run a business, a regular weekly income, any debts owed to family or friends, any court fines or legal fees (this is a non-exhaustive list and provided to give examples). Neurodegenerative Condition; The Players Foundation Charity is committed to supporting beneficiaries who have been diagnosed with neurodegenerative condition. We understand that finding the right support at such an emotional time can be extremely difficult and the team is happy to help you liaise with your GP and Adult Social Services to ensure you receive the appropriate advice and information. We work closely with our partners at DISC (discdementiasupport.org) and together we are able to provide support from the moment a diagnosis is given. Firstly, DISC will ensure that you are receiving all the help and benefits – both practical and emotional – you are entitled to through the Local Authority. If DISC consider you may benefit from financial support with, for example, home adaptations or help with a utility bill or any debt-related problems arising from a dementia diagnosis, they will assess your needs and refer you to the Trustees who will consider any application directly related to improving the condition of the person living with dementia. The Players Foundation will assess individual beneficiary’s circumstances. If the assets of the beneficiary do not exceed £23,250 (this does not include the value of a beneficiary’s home unless it is vacant) we will do what we can to assist within our Policy. Income of other members of the household will never be taken into account. The reason we impose financial criteria thresholds and individual beneficiary limits on all applications is to enable the Foundation to direct resources to those most in need of financial support. The Charity requires 3 comparable quotes for any request. How long will it take for my application to be considered? Application processing times is dependent upon the volume of application receipts. We aim to provide indication of current processing times on acknowledgement of receipt of your application. It is important you complete the form in full and that you include the supporting documentation. Incomplete forms and/or where documents are missing will delay your application. Approved grants MUST be fulfilled within a 3 month period, after which a new application will need to be completed. The Players Foundation complaints and appeals policy can be found on our website www.theplayersfoundation.org. All applications are treated with the strictest confidence and sensitivity and will be individually assessed. Confidential Please answer every question. Personal Details Title First Name* Last Name* Address and Postcode* Email address* Contact telephone number* Date of Birth* PFA Number Date joined the PFA Details of club history (to include relevant seasons)* Current employment status What is your occupation? Are You? SingleMarried/Civil partnership/living with partnerSeparatedDivorcedWidowed Details of spouse/partner First Name of spouse/partner Surname Date of Birth Are they living at the above address? —Please choose an option—YesNo What is their occupation? Are they aware you made this application? —Please choose an option—YesNo Accommodation type Own homeRented local authority/housing associationPrivated rentedSheltered housingShared ownershipResidential CareLiving with parents How long have you lived at this address? If you own your home, what is the current value £ Mortgage outstanding £ Do you have additional properties/buy to let? —Please choose an option—YesNo Who else shares your home with you (including children under 18) Name Age Relationship to you Are they in education, employed, other - please give details If working, please give details of any financial contribution towards household costs £ If you are financially responsible for someone not living in your home, please tell us their name, relationship to you and the level and reason for financial support. Please give details of any other organisations you have approached for help financially / emotionally / practical. Organisation Brief Detail Outcome Amount Awarded £ Reason for applying to The Players Foundation Charity Please tell us the reason for your application for example: • Why you are experiencing severe financial difficulty, and how long have you been experiencing problems. • If unforeseen circumstance, please explain the circumstance and the effect it has had on your finances. • If you have unserviceable debts, please explain the reason for these debts. • You or your partner are unemployed or off work due to other reasons, please give details and anticipated return to work date. • You or a family member are living with a neurodegenerative disease and require advice and support – please give as much details as possible. • Please provide any additional information to support your application and help us understand your situation. How would you like us to help. Please note we may not always be able to help with everything and financial support could be in the form of a contribution to assist your situation. There are however things we are unable to support with, but we will endeavour where possible to offer advice and support in other ways. What do you need help with Indication of cost £ Financial section for you Frequency: W=weekly F=fortnightly 4=4-weekly M=monthly Q=quarterly Income Self £ Frequency Salary/work related benefit —Please choose an option—WF4MQ Employment -net figure after tax —Please choose an option—WF4MQ Employment -2nd job net figure after tax —Please choose an option—WF4MQ Occupational/Statutory sick pay —Please choose an option—WF4MQ Working tax credits —Please choose an option—WF4MQ Working & Child tax credits combined —Please choose an option—WF4MQ Job seekers allowance —Please choose an option—WF4MQ Pension & age-related benefits —Please choose an option—WF4MQ Occupational/private pension —Please choose an option—WF4MQ State retirement pension —Please choose an option—WF4MQ Pension credit —Please choose an option—WF4MQ Child benefit —Please choose an option—WF4MQ Child tax credit —Please choose an option—WF4MQ Child Maintenance —Please choose an option—WF4MQ Statutory maternity pay/allowance —Please choose an option—WF4MQ Disability/illness —Please choose an option—WF4MQ Employment support allowance —Please choose an option—WF4MQ Carers allowance —Please choose an option—WF4MQ Bereavement support payment —Please choose an option—WF4MQ Widowed parents’ allowance —Please choose an option—WF4MQ Industrial injuries benefit —Please choose an option—WF4MQ Student loan bursary —Please choose an option—WF4MQ Universal credit/Income support —Please choose an option—WF4MQ Housing benefit —Please choose an option—WF4MQ Discretionary housing payment —Please choose an option—WF4MQ Other (please specify) —Please choose an option—WF4MQ —Please choose an option—WF4MQ —Please choose an option—WF4MQ Financial section for your partner Frequency: W=weekly F=fortnightly 4=4-weekly M=monthly Q=quarterly Income Partner £ Frequency Salary/work related benefit —Please choose an option—WF4MQ Employment -net figure after tax —Please choose an option—WF4MQ Employment -2nd job net figure after tax —Please choose an option—WF4MQ Occupational/Statutory sick pay —Please choose an option—WF4MQ Working tax credits —Please choose an option—WF4MQ Working & Child tax credits combined —Please choose an option—WF4MQ Job seekers allowance —Please choose an option—WF4MQ Pension & age-related benefits —Please choose an option—WF4MQ Occupational/private pension —Please choose an option—WF4MQ State retirement pension —Please choose an option—WF4MQ Pension credit —Please choose an option—WF4MQ Child benefit —Please choose an option—WF4MQ Child tax credit —Please choose an option—WF4MQ Child Maintenance —Please choose an option—WF4MQ Statutory maternity pay/allowance —Please choose an option—WF4MQ Disability/illness —Please choose an option—WF4MQ Employment support allowance —Please choose an option—WF4MQ Carers allowance —Please choose an option—WF4MQ Bereavement support payment —Please choose an option—WF4MQ Widowed parents’ allowance —Please choose an option—WF4MQ Industrial injuries benefit —Please choose an option—WF4MQ Student loan bursary —Please choose an option—WF4MQ Universal credit/Income support —Please choose an option—WF4MQ Housing benefit —Please choose an option—WF4MQ Discretionary housing payment —Please choose an option—WF4MQ Other (please specify) —Please choose an option—WF4MQ —Please choose an option—WF4MQ —Please choose an option—WF4MQ Are you in receipt of any of the following? Self £ Partner £ Disability living allowance – care: Low / Middle / High Disability living allowance – Mobility: Low / Medium / High Personal Independence payment – Living: Standard / Enhanced Personal Independence payment – Mobility: Standard / Enhanced Attendance Allowance Severe disablement premium - Care Do you have any benefit applications pending? Yes / No —Please choose an option—YesNo —Please choose an option—YesNo If ‘yes’ which benefits Please confirm if you have recently been assessed for your entitlement to means test benefits YesNo If "No" we will refer you to our Welfare Rights Advisor for an assessment to be carried out. Expenditure Amount £ Frequency Mortgage/Rent (amount you pay after deducting any benefit assistance) —Please choose an option—WF4MQ Second mortgage / Secured loan —Please choose an option—WF4MQ Council tax (amount you pay after deducting any benefit assistance) —Please choose an option—WF4MQ Water rates —Please choose an option—WF4MQ Buildings insurance —Please choose an option—WF4MQ Contents insurance —Please choose an option—WF4MQ Child maintenance —Please choose an option—WF4MQ Life insurance —Please choose an option—WF4MQ Income Protection —Please choose an option—WF4MQ Fuel – Gas —Please choose an option—WF4MQ Fuel – Electric —Please choose an option—WF4MQ Fuel – Oil/Coal —Please choose an option—WF4MQ Childcare / Carer costs —Please choose an option—WF4MQ Car insurance —Please choose an option—WF4MQ Road tax —Please choose an option—WF4MQ Food shop —Please choose an option—WF4MQ School meals —Please choose an option—WF4MQ Phone landline & mobile —Please choose an option—WF4MQ TV Licence —Please choose an option—WF4MQ TV – satellite / cable / broadband package —Please choose an option—WF4MQ Other (please specify, do not include debt repayments) —Please choose an option—WF4MQ —Please choose an option—WF4MQ —Please choose an option—WF4MQ Debts and Arrears Please give details of all debts (please use separate sheet if required) Type of debt e.g. council tax, car loan, credit card, rent etc Creditor – who the money is owed to How much do you owe £ Is it in arrears or balance outstanding £ Monthly repayment £ Have you taken debt advice? YesNo If yes, who was this with and how long ago? If no, we will put you in touch with our debt advisor if required. Savings Include savings for both people when living as a couple Details Amount £ Total in current accounts (complete total including partners) Total in savings accounts (complete total including partners) Shares / ISAs (complete total including partners) Grant payment If a grant payment is agreed, one or more of the following methods of payment will made: • Payment into your bank account • Direct to creditor or supplier – where help is given to pay a bill or invoice for supplying of goods. Name of Bank Name on Account Account No Sort Code Declaration I agree that all the information provided in the application form is true and correct, and a full disclosure of all income, capital, savings, and investments has been made. Making a false declaration is an offence.* I will inform The Players Foundation of any change in circumstances that I may have during this application.* Please make sure you have agreed to the above declaration by ticking the box. We are unable to process your application unless this is done. By signing this form, you acknowledge agreement to the use of information provided in line with The Players Foundation GDPR Policy. Type Name of beneficiary / person completing the form* Date* Relationship to beneficiary? (if applicable) Do you hold an LPA if signing on behalf of beneficiary —Please choose an option—YesNo Documents required to support your application. If you and/or your partner are working, please enclose copies of the last 3 months pay slips for both parties (if applicable) You and/or your partners complete bank statements for the last 3 months for all accounts held – statements should clearly show name and address. Copies of any recent correspondence from your creditors or debt recovery agency If applying for goods / home adaptations, we require 3 comparable quotes. Proof of photo identification, this can be in the form of a photocard driving licence or passport and a copy of an official letter confirming your address. Failure to provide any of the above documentation may result in a delay in processing or rejection of your application.
