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Application Form
Application Form
Step
1
of
9
11%
Application to apply for financial assistance
This form must be used in the following circumstances: a) first application to Police Children’s Fund b) applying for reinstatement c) annual review for registered beneficiaries.
Full Name of Applicant
*
Your name
Address
*
Street Address
Address Line 2
City
Post Code
Phone
*
Email
*
Officer's Details
Force
*
Officer's Full Name
*
Officer's Date of Death
DD slash MM slash YYYY
OR
Officer's Date of Medical Retirement
DD slash MM slash YYYY
Child's Details
Child's Details
Full name
Age
Date of Birth
Adults
*
Children
*
Total residents at this address
Savings and Investments
Please give details of funds held in savings and investments at present
Monthly Income – please give Net figures. Anything received annually must be divided by 12. Benefits and credits should be listed at Step 6
Monthly earnings (self)
Monthly earnings (spouse/partner/other family members)
Police Pension (self)
Police Pension (children)
State Pension
Occupational Pension
Bereavement Support Payment
Police Charities: Police Care UK, COPS, Force Welfare/Benevolent Fund etc
Police Children's Fund
CSA / Maintenance Payments
Rent from additional property
Total income generated from savings and investments declared at step 3 (calculated on a monthly basis)
Other Income
Details of other income
Benefits & Credits – please give monthly figures
Child Benefit
Universal Credit – total per month
Please itemise Universal Credit
Other benefits & credits
Please itemise other benefits & credits
Total monthly income and benefits
Monthly Expenditure
Anything paid annually must be divided by 12
Mortgage / Rent (including service charge)
Council Tax
Property Maintenance / DIY
Water Rates
Electric / Gas / Oil / Solid Fuel
Life Assurance
Home Insurance (buildings / contents)
CSA / Maintenance Payments
Food, drink, laundry, cleaning & toiletries
Clothing – not including school uniform
Landline
Mobile Phones
Internet & TV Packages
Educational Expenditure (uniform, meals, transport, course fees)
Private School Fees
TV Licence
Vehicle Breakdown Cover
Vehicle Fuel
Vehicle Insurance
Vehicle Servicing & MOT
Number of Vehicles
Children's Pocket Money
Pet Expenses
Child Care
Hairdressing
Regular Subscriptions / Charity Donations
Hobbies / Sports / Recreation
Public Transport
Prescriptions / Dental / Glasses/ Lenses / Health Cover
Social / Entertainment
Other Expenses (holidays, lottery, birthdays & Christmas)
Details of other expenses
Total Monthly Expenditure
Monthly Credit Commitments / Finance Agreements (loans, vehicles, furniture, appliances)
Credit cards used to purchase clothing and daily essentials listed above should not be included here
Purchase Details
Details
Amount per month
Date of final payment
Additional information to support the application
Declaration and Consent
*
I consent to the information I have provided being held and processed by Police Children’s Fund as necessary for the administration of this and any other application I make to the Fund.
I declare that the information I have provided is accurate to the best of my knowledge and that false or inaccurate information could result in my application being denied or in the loss of Fund assistance.
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