Confidential This application applies to a limited fund campaign to support beneficiaries on low income. Beneficiaries meeting the criteria have access to a financial grant to assist with Winter Fuel payments. 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 Who shares your home with you (including children under 18) Name Age Relationship to you Are they in education, employed, other - please give details Annual Income Self £ Partner £ Salary - gross figure Salary - 2nd job gross figure Which of the following means tested benefits are you in receipt of? Self £ Partner £ Universal Credit Pension Credit Income Support Income-related Employment and Support Allowance (ESA) Income-based Jobseeker’s Allowance (JSA) Child Tax Credit Working Tax Credit Do you consider yourself to be in a vulnerable situation or requiring additional support at this time? If yes, please provide details to help us understand your needs.* 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.
