Application for School Clothing Grant and Free ... - Falkirk Council

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Application Form: Clothing Grant/Free School Meals Entitlement 2013/14
It is important that you read the guidance notes on pages 1 & 2 before completing this application form. You must
provide us with your bank/building society account details for clothing grant payment.
ABOUT YOU
Your Name: Title:
Forename:
Surname:
Your National Insurance Number:
Contact
Numbers:
Address:
Home:
Mobile:
Postcode:
HAVE YOU PREVIOUSLY APPLIED FOR FSM AND CLOTHING GRANT? If yes tick box.
ARE YOU A LONE PARENT? If yes tick box
By ticking this box, I authorise a check of my circumstances against Council Tax Records for proof of single
occupancy. You may need to provide additional information if other adults live at the same address.
PARTNER’S DETAILS:
NAME:
PARTNER’S NATIONAL INSURANCE NUMBER:
ABOUT YOUR CHILDREN - PLEASE LIST NAME OF EACH CHILD , THEIR DATE OF BIRTH AND SCHOOL THEY
WILL BE ATTENDING FROM AUGUST 2013.
PLEASE NOTE IF ANY OF YOUR CHILDREN ARE OVER 16 YEARS AND STAYING ON AT SCHOOL - THEY MUST APPLY
FOR EMA - PLEASE CONTACT YOUR ONE STOP SHOP/REGISTRATION OFFICE FOR FURTHER INFORMATION.
CHILDS FIRST NAME CHILDS SURNAME DATE OF BIRTH AGE SCHOOL ATTENDING AUGUST 2013
BANK ACCOUNT DETAILS: (POST OFFICE ACCOUNTS CANNOT BE ACCEPTED)
ACCOUNT HOLDERS NAME:
BANK/BUILDING SOCIETY BRANCH NAME:
SORT CODE: ACCOUNT NUMBER:
If you have provided bank account details that are not your own please tick the box
N.B Falkirk Council will not be held responsible if incorrect bank account details are provided or
for any payments made into a third party account that are not passed on to the claimant.
IF YOU DO NOT HAVE A BANK ACCOUNT AND WISH A CHEQUE PAYMENT TICK HERE:
Office use only
Ref No.