Application forassistance

Please return the completed form tothe Head of Members Fund Operations, Incorporated Society of Musicians, 4-5 Inverness Mews,LondonW2 3JQor .

Your personal details

Surname
First names
Address
postcode
Telephone / home
mobile
Email
Date of birth
Marital/partnership status

Family details: your partner

Name
Date of birth
Occupation

Family details: children and other dependants

Name / Date of birth / Relationship to you / In full-time education or working? / Amount by which you assist them / Living with you?

Consent(to be signed by both you and your partner)

I/we declare that, to the best of my/our knowledge, the information provided above is accurate.

I/we consent to the processing by ISM staff of the data I/we have provided on this form and in other communications with the ISM Members Fund. I/we consent to the disclosure of the same data by ISM staff, where necessary for assessing my/our application, to other charities and organisations. I/we further consent to the processing of the data by those charities and organisations.

Signed (applicant)Date

Signed (applicant’s partner) Date

Notes on completing this form

The ISM Members Fund exists to help current and past members of the ISM and the partners or dependants of a deceased member who are in need. This help usually takes the form of a one-off grant or ongoing financial support but we can also point you to other sources of advice and support, both financial and non-financial.

We do not interpret “necessitous” as meaning extreme poverty. If you are experiencing significant financial strains or at risk of falling into financial difficulties, you should contact us for help immediately. Such difficulties may be the result of a wide range of issues, including injury or prolonged illness, family problems or simply a less than adequate retirement income.

The Head of Members Fund Operations, Caroline Aldred, would be pleased to have an informal discussion with you before you make a formal application for a grant. This gives you an opportunity to talk through your situation and how the Fund might best be able to help you. You can contact Carolineat or on 020 73139310.

We ask for a lot of financial information on this form because we need to be sure that all successful applicants meet the Fund’s criterion of being in need. The guidance notes on each page should help you to decide what figures to put there. Caroline Aldred would be happy to answer any other questions you may have about filling in the form.

You may want to ask a family member or friend to help you complete the form. However, you yourself should still sign it on the first page.

Please be sure to explain why you are applying in Section 2 of the form.

Tostrengthen your case for assistance and speed up the application process please send us copies of supporting documents atthe same time as your completed application form. Examples of such documents include:

  • your recent bank statements
  • your latest tax return and/or set of accounts
  • official letters confirming the amount of any welfare benefits you receive
  • medical letters confirming any illness or injury and
  • quotations for any large expenditure items for which you are applying for a grant.

In any case, you may find it helpful to have these documents ready to hand before you start filling in the form so that you can refer to them.

Once we have received your completed form and any additional information we need to ask for, your application will be presented on a totally anonymous basis to the Fund’s Grant-Making Committee for their decision. We aim to inform you of their decision within three weeks of receiving full information.
Section 1: Work

Your work

Are you working / not working? (Please delete which does not apply)

If employed, who is your current employer?
Your job title
Date this employment started
If self-employed, what work do you do?

Your partner’s work

Is your partner working / not working? (Please delete which does not apply)

If employed, who is his/her current employer?
His/her job title
Date this employment started
If self-employed, what work does he/she do?

Section 2: Reasons for your application

Please state why you are applying for help and provide additional information in support of your application. This should include details of any relevant medical condition or disability and any recent adverse changes in your circumstances (or changes which are about to occur).

Section 3: Your household income

Please give us an idea of your income in normal times. If your current income is different from this please give the current figures in Section 2.

In the column headed “frequency” please indicate the frequency at which you receive the figure given for each item (eg weekly, fortnightly, monthly, termly, annual). Feel free to use different frequencies for different items.

Frequency / Yourself / Your partner / Office use only
Pensions / private/occupational
state
Income from employment / net of income tax and National Insurance deducted
Self-employed gross income / before deducting tax and expenses
Welfare benefits
Please include all benefits you
receive. The list below may help you.
Investment income / your income from interest, dividends etc,
Rents received / from lodgers & letting property
Help from family
Any other income (please specify)
LESS tax paid / if any of the figures above are gross of tax

Note on welfare benefits

You should include in the table above the amounts you receive in the form of any of the following benefits:-

Attendance Allowance / Housing Benefit
Bereavement Allowance / Pension credit
Carers Allowance / Personal Independence Payment
Council tax subsidy / Statutory Sick Pay
Disability Living Allowance / Working tax credit

Section 4: Your household expenditure

Please tell us your household’s spending on the following items.

Expenditure item / Yourself / Your partner
Your monthly rent including any part covered by Housing Benefit
Your monthly mortgage payment
Your annual business expenses, i.e.
the amount of your tax-allowable expenses from your last tax return
Any other expenditure items you think we should know about

Section5: Your capital

Please tell us about the assets you own.

Please show the value of these assets / Yourself / Your partner
Bank and building society deposits
ISAs
Other pension savings
Other savings & investments
(including shares, unit trusts etc not within an ISA)
Owned property – main home
- other
Other (please specify)

Section6: Your debts

Yourself

Amount outstanding / Monthly payments
Mortgage
Bank loans
Bank overdraft
Credit and store cards
Arrears on household bills
Loans from family and friends
Other (please specify)

Your partner

Amount outstanding / Monthly payments
Mortgage
Bank loans
Bank overdraft
Credit and store cards
Arrears on household bills
Loans from family and friends
Other (please specify)

Section 7: Applications to other charities

Please give details of any other charities to which you are applying.

Name of charity / Date of your application / Assistance received