Funding Request

Important:

The application must be completed in one sitting.

After you've applied we will be back in touch shortly regarding your application.

Step 1 - Organisational Contact Details

Organisation name

Type of organisation

If other, please specify

If part of a larger organisation, please provide a unique identifier that your accounts office will recognise

Registered charity number (if applicable)

Organisation Address

Address line 1

Address line 2

Address line 3

Address line 4

Postcode

Contact telephone number

Contact email address

Step 2 - Main Person Contact Details

Title

First name

Surname

Position in organisation

Step 3 - Your Application to Support a Person in Hardship (Your Client)

Clients name (please don't use Mrs, Mr, Miss before first name)

Clients date of birth

Address to deliver items

Address line 1

Address line 2

Address line 3

Address line 4

Postcode

In what capacity is the client known to you?

How long has the client been known to you?

Has your client received a funding from YesTax within the last 12 months?

What item does your client most need?

If other, please specify

How much does the main item cost? (£)

How will you fund the difference? (if any)

Step 4 - Your Client

Number of dependent children

Ages of children in household

Employment status

Number of adults (18 years+) in the household

Their relationship to your client

Step 5 - The Benefit Funding Could Make

Reasons for and background to the application. Why is this item needed?

What difference will this funding make to the family?

Mobile contact number

Declaration and Submission

By ticking the box you declare that the applicant has given their authority to act on their behalf. You confirm that the information given in the form is true to the best of your and your organisation's knowledge. It is your responsibility to ensure that the funding is spent appropriately and receipts provided for all purchases which must be made available to us on request.

I have read and understood the statement above

I have read and agree with your Privacy Notice