BFT – Form AF1

Please read this form fully before completing.
In confidence when completed
Application for Financial Assistance from the Brixton Feoffee Trust
* Please circle the appropriate word
Name:
Address:
Post Code:
Telephone Number:
Mobile Telephone number: / Email Address:
Length of time at this address:
Previous address if less than 3 years:
Is your property? * Owned *Rented
Are you *Married *Separated *Divorced *Single
Please give your age by putting a ring round one of the following groups :-
18 to 30 31 to 60 61 +
Particulars of sons and daughters (including Adults) and dependents
Name / Age / Living at home or away / Relationship to applicant / Employed/unemployed or student
Are you?
*Employed *Unemployed *Self Employed * Job Seeker *Retired * Training *At School/College
If employed please give details below.
Details of Employment
Occupation / From date / To date / Employers name

(General Help for Individuals – application form – page 1)

Income
Amount Details
Wages / £
Pensions (please list national, and any personal pensions received and amounts / £
Benefits (please state any benefits received, for example, Housing Benefit, Council Tax relief, Income Support, Job seeker’s allowance, Income Support, child benefit, disability living allowance, carer’s allowance, child benefit) / £
£
£
£
£
Total (per month or per week, please indicate) / £
Savings and capital
Total savings (including capital, investments bank, building society etc.) / £
Previous Assistance received from Brixton Feoffee Trust
Amount of Grant Required
Please tell us what you require the grant for
(if you would like to give more details, please continue on the next page). / Amount required
£ / Contribution from applicant, family and friends and elsewhere with details
Signature of Applicant
Date

Brixton Feoffee Trust

The Feoffee Trust was formed in the 1400s. Today the Trust helps individuals in genuine need who cannot obtain assistance from other sources.

The Trustees ask that applicants have lived in the parish for a year;

however this is under review

The Trustees are obliged by Charity Commission regulations to ensure that applicants have explored any other funding available; therefore The Trustees request that you have undertaken this task before completing this application form.

All Applications are COMPLETELY CONFIDENTIAL

and will not be shared with any other parties.

Please ask the Trustees any questions you have regarding your application- we are here to help. If you need any help in filling in this form please contact Sally Axell, Clerk to the Trustees, Brixton Feoffee Trust, on 01752-880262.

(General Help for Individuals – application form – page 2)

The Trustees would appreciate any more information you can give
regarding the background and reasons for your application. If
you would like to add anything, please do so in the space below. You are welcome to add more details on more sheets if you wish.

Please either hand to a Trustee or send to the Clerk to the Trustees, Mrs. Sally Axell, at 15 Cherry Tree Drive, Brixton, Plymouth, PL8 2DD.

(General Help for Individuals – application form – page 3)