Berkshire Flood Recovery Fund –

Application Form

Our first priority is to get Emergency Relief Grants of £250 as swiftly as possible to vulnerable people1 whose homes have been recently flooded (December 2013-February 2014) to alleviate immediate financial hardship caused by the floods.

Example uses for grant: temporary accommodation, meals, hiring dryers, sourcing alternative heaters or cookers, cleaning up, high insurance premiums. They can also be used for emergency repairs and replacement of damaged fixtures and fittings if these are essential to the welfare of the applicants and are not covered by insurance. This list is not exhaustive. For the avoidance of doubt ‘home’ refers to the applicant’s main place of residence, and to the living space (i.e. not gardens or outbuildings).

Priority in this round is being given to the most vulnerable households1 and those on low incomes. The scheme is not means-tested but we do need to understand the financial hardship experienced as a result of your home being flooded.

Losses that are, or will be, covered by insurance are ineligible.

The application form requires you to explain how the flood is affecting your household and how the grant will alleviate financial hardship. Please complete these sections as fully as you can within the space available. It will help us to understand the impact upon your household and how a grant will alleviate the hardship and disruption you are experiencing. If you do not complete these sections sufficiently, we may not be able to award you a grant.

The form must be independently countersigned by someone in a position of authority who can confirm you have been flooded. For example this could be a local parish councillor, member of the clergy, or someone from emergency services.

If you need help in filling the form out, please call us on 0118 930 3021.

Once completed please send this form to Berkshire Community Foundation, Abbey House, 1650 Arlington Business Park, Theale, RG7 4SA or email a scanned copy to .

Confidentiality

Personal information recorded on this form will be treated confidentially by Berkshire Community Foundation although we may need to share data with our partners in order to achieve swift and timely response to your needs. In such cases we will require our partners to also respect your confidentiality. Data may be used for monitoring purposes.

Fraud

Grants awarded to fraudulent applications will be claimed back.

1 Households with residents over 65, or with children under 5, people with long-term illness, people less able to cope (e.g. those with learning difficulties or mental health) and on low incomes.

Emergency Flood Recovery Fund
Grant Application
(All questions are mandatory unless indicated otherwise. We may not be able to consider incomplete applications)
Name of applicant:
Address:
Postcode
Tel no:
Email:
If you are unable to use your normal telephone number or email, please provide alternative contact details:
Household members / Number
Age 65 or older
Age 18-65
Age 5-18
Age 5 or younger
Do any of your household members have a disability, long-term illness or suffer from mental health illness? Yes/No
Date(s) your home* was flooded:
*For the avoidance of doubt, ‘home’ refers to your main place of residence and does not include gardens or outbuildings. In rented property, tenants rather than landlords should apply. Second or holiday homes are not eligible.
Please describe the impacts the flood has had on your household as a result of your home being flooded, and in particular where you have incurred additional financial costs:
Please describe how an Emergency Grant will help your household overcome financial hardship (even if it is temporary) caused by the flooding:
Optional Information
You do not have to fill these sections out but they will help us understand your situation and prioritise our support if necessary.
Do you have Building Insurance? Yes/No
Do you have Contents Insurance? Yes/No
If ‘No’, please briefly explain why not:
Are you in receipt of benefits? Yes/No
If ‘yes’, please tell us which ones?
Payment Details
As grants will normally be paid by cheque please give the account name you wish the cheque to be paid into.
Name of account
If you are asking us to pay the grant to someone else to hold on your behalf please explain why here.
Declaration
Applicant
I confirm that my home has been flooded during the December 2013/February 2014 flood and the information in this form is correct.
Signed………………………………………
Print Name………………………………… / Date ……………………………………..
Countersignature (to be signed by a person in a position of authority e.g. local parish councillor, member of the clergy, or someone from emergency services.)
I confirm that the applicant’s home has been flooded during the recent floods and the information in this form is correct to the best of my knowledge. I will treat the information in this application in the strictest confidence.
Signed………………………………………
Print Name………………………………… / Date……………………………………..
Role/Position ……………………………………………………………………………..
Contact tel/email………………………………………………………………………….