Please set out why you are seeking financial assistance from Berkswell Charities CIO (Charitable Incorporated Organisation) and the donation sought?

Please give details of your personal circumstances. NB grants will only be made on the basis of financial need.

1. Copy photographic identification 2. Evidence of income from all sources to include at the very least your last 3 months' pay slips, last 3 months bank statements and if self-employed your last set of accounts and tax return. Evidence of any savings in the United Kingdom or elsewhere 3. Evidence of any property owned in the United Kingdom or elsewhere 4. Evidence of any other assets 5. Evidence of any debts you may have 6. Evidence of your monthly outgoings 7. Evidence why financial assistance is sought from Berkswell Charities

Please ensure that the following documents are submitted with this application. Failure to supply sufficient documentary evidence in support will jeopardise your application and delay a decision. 1. Copy photographic identification 2. Evidence of income from all sources to include at the very least your last 3 months' pay slips, last 3 months bank statements and if self-employed your last set of accounts and tax return. 3. Evidence of any savings in the United Kingdom or elsewhere 4. Evidence of any property owned in the United Kingdom or elsewhere 5. Evidence of any other assets 6. Evidence of any debts you may have 7. Evidence of your monthly outgoings 8. Evidence why financial assistance is sought from Berkswell Charities

Data Protection Statement: It is part of the Trustees’ responsibilities to ensure that applicants for donations are suitably qualified under the terms of the charity’s governing document. Trustees, therefore, need to investigate the personal circumstances of applicants. The Charity complies with the regulations for data security under the General Data Protection Regulations (GDPR). The data we collect has been classified as Sensitive Data under Article 9 of GDPR. We have strong procedures and policies in place to protect the collection and storage of this data. The personal data supplied on this form and other information will be held on file.

To process, monitor, analyse and report on the applications we receive, we may need to record data about you and your family if appropriate. The law says we must get your consent to do this. The Trustees, their legal advisors and auditors will treat everything you tell us confidentially. We, therefore, require your signature to proceed and consider your application. I/We give consent to Berkswell Charities to record personal data and personal data contained in this application and use it for the purposes indicated. I/We confirm that we have received Berkswell Charities Privacy Notice and understand and agree with the contents. I/We DECLARE that I/We will use any award made for the purpose requested in this application and shall provide documentary evidence of this to the Trustees and in the event, I/We fail to do so the monies shall be returned to Berkswell Charities. I/We declare that the information contained in this form reflects a true and accurate disclosure of all assets, liabilities, and facts. Any failure to disclose relevant information to the Trustees shall result in any Donation that may be made being recouped.