Confidential This application applies to a limited fund campaign to support our beneficiaries who have a family with dependants under 18, a household income of under £50k and/or in receipt of means tested benefits. Beneficiaries meeting the criteria have access to a financial grant to assist with basic day to day family living costs such as food provisions during school holidays, the provision of school uniform and educational resources. Applications will be processed based on the information provided. Applications will only be processed where all questions have been answered. Knowingly providing false or misleading information could lead to a criminal offence being committed. 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 Name of spouse/partner First name of spouse/partner Last Name 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 Details of dependents living with you under 18 Name Age Relationship to you Name of School / College School Year Do they receive free school meals? Do they require school uniform? Annual Income Self £ Partner £ Salary - gross figure Salary - 2nd job gross figure Do you receive Child Benefit, if so, how much? —Please choose an option—YesNo Which of the following means tested benefits are you in receipt of? Self £ Partner £ Universal Credit Pension Credit Income Support Income-based Jobseeker’s Allowance (JSA) Child Tax Credit Working Tax Credit How will you spend this grant? i.e., school uniform, school holiday food provisions etc. Grant payment 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.* 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 Documentation Required Please enclose an official letter confirming proof of your benefits payment (if applicable) Please enclose copies of the last 3 months pay slips for both parties (if applicable), if self-employed your latest tax return If you have not provided your PFA membership number, we will require proof you meet our beneficial class i.e., copy of an old playing contract. 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.
