Application for A Short Welfare Break - RAF Benevolent Fund
Application for A Short Welfare Break - RAF Benevolent Fund
Application for A Short Welfare Break - RAF Benevolent Fund
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E. APPLICANTS WEEKLY HOUSEHOLD INCOME & EXPENDITURE (verified from relevant documents)<br />
Is the applicant, to the best of your knowledge, in receipt of all applicable state benefits, rebates and allowances?<br />
Yes No What action is being taken?<br />
EXPENDITURE Verified Weekly Arrears INCOME<br />
Weekly<br />
£ p £ p £ p<br />
Rent (less Housing benefit)<br />
Earnings of Applicant (inc overtime but less Tax and NI)<br />
Mortgage<br />
Council Tax<br />
Housekeeping<br />
Gardener<br />
Electricity<br />
Gas<br />
Water Rates<br />
Other Fuels<br />
Insurance (not NI)<br />
Television<br />
Satellite<br />
Telephone<br />
Broadband<br />
Taxi/Bus fares<br />
Car<br />
Scooter/EPV costs<br />
Personal/Debts/loans/HP<br />
Hairdresser<br />
House Repairs<br />
Pets (state if guide/assistance dog)<br />
Window Cleaner<br />
Cleaner<br />
Carer<br />
Prescriptions<br />
Alternative therapy<br />
Other (please specify)<br />
Earnings of spouse/partner<br />
Job Seekers/Income Support<br />
Statutory Sick/Maternity Pay<br />
Maintenance received<br />
State Retirement Pension<br />
Service Pension<br />
Occupational Pension<br />
War Disablement Pension ( %)<br />
Pensions – Spouse<br />
Disablement Pension ( %)<br />
Incapacity Benefit/Employment Support Allowance<br />
Widows Pension (War/NI)<br />
Child Benefit/Special Allowance<br />
Working Tax Credit<br />
Universal Credits<br />
Industrial Injuries Disablement Benefit<br />
Severe Disablement Allowance<br />
Disability Living Allowance – Care Component<br />
Disability Living Allowance – Mobility Component<br />
Attendance Allowance<br />
Disability Working Allowance<br />
Pension Credit<br />
Carers Allowances<br />
Other income (give details)<br />
Total<br />
Total<br />
Savings/Capital/Investments Please show amount of savings eg. Bank, Building Society, National Savings etc £<br />
Any other long-term investments? State what they are £<br />
F. SHORT WELFARE BREAK FOR APPLICATIONS TO PMH<br />
Period of stay requested is ONE WEEK TWO WEEKS The preferred day of arrival is<br />
State briefly the need <strong>for</strong> such a break<br />
TUESDAY<br />
WEDNESDAY<br />
I/We need<br />
days’ notice or I/We can accept a cancellation at short notice<br />
THURSDAY<br />
April 2012
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