APPLICATION FOR FINANCIAL ASSISTANCE - Charis Grants

APPLICATION
FOR FINANCIAL ASSISTANCE
BEFORE COMPLETING THE APPLICATION FORM, PLEASE CAREFULLY READ THE NOTES BELOW
When you have completed the application form, you should detach these notes and keep them for your reference
ALTERNATIVELY APPLY ONLINE VIA THE FUND’S WEBSITE
WWW.NPOWERENERGYFUND.COM
The Three Veolia Valleys Water Water Trust Trust is a charitable is a charitable Trust Trust and and is referred is to to as as “The Trust” throughout this form.
BEFORE COMPLETING THE APPLICATION FORM, PLEASE CAREFULLY READ THE NOTES BELOW.
WHO
When you
CAN
have
APPLY
completed
FOR
the application
A GRANT
form, you should detach these notes and keep them for your reference.
You The can npower apply Energy to the Fund Trust if is you referred are in to need, as “the poverty, Fund” hardship throughout or distress this form. and you live within the regions
supplied by Veolia Water Central (formerly Three Valleys Water), Veolia Water East (formerly Tendring
WHO CAN APPLY FOR A GRANT
Hundred Water) and Veolia Water Southeast (formerly Folkstone and Dover Water).
• You can apply if you are a current domestic account holder (the person/persons named on the bill) of npower
and are in need, hardship or other distress.
The account holder (the person(s) named on the bill) can apply for help with water debts. If the account
holder
• Only the account holder can apply for help with gas or electricity debts. If the account holder is unable to make
is unable to make the application for grant, please explain why someone else is doing so on his or
the application for a grant, please explain why someone else is doing it on his or her behalf. The account holder
her must behalf. still sign the form.
Anyone HOW living CAN within THE the FUND regions supplied HELP by Veolia Water can also apply for a grant to clear other priority
debts and purchase essential household items. These grants are call Further Assistance Payments (FAPs).
The Fund can help clear debts for domestic electricity and gas owed to npower.
FILLING IN THE APPLICATION FORM
HOW • Please CAN complete THE all sections TRUST of the HELP application form. If a section is not applicable, insert N/A.
• Before completing this application form you are strongly advised to obtain free independant money / debt advice. This
is The likely Trust to increase can help your you chance to clear of success debts for to the domestic Fund, water and electricity help charges. you and to gas. address your debts and keep up to date with
current
The Trust bills. can sometimes help you to clear other priority debts and purchase essential household items. (FAPs). You can
• If You you
apply can need
for apply help
such for with
help such your
even help electricity
if you even and/or
do if not you apply do gas not debts,
for apply you
help for must
with help provide:
your with electricity your water or gas charges. debts.
• A copy of your most recent bill, showing actual usage - NOT estimated.
• The A meter Trust cannot reading give taken you on a the loan date or give you you submit help your with application bills that you (see have section already 6). paid or with items that you
have Guidance already on bought.
how to read your meter is given on the the back of your bill, or call your supplier.
• It is very important that you give us as much information as possible about your circumstances.
You The must Trust send also cannot us proof help of your income. with the All following:
evidence must be • less Over than payments 3 months of old benefits with the exception of
annual benefit letters for Works Pension / State Pension / Disability Living Allowance (DLA) and Child Benefit.
• Fines for criminal offences
Over • Business payments debts of benefits
• Please supply copies of all supporting documents as we do not return originals.
• If
• you Educational need help with or training the form needs
you should contact a local advice
centre
Business • Catalogues, such
Debts
as a Citizens credit cards, Advice personal Bureau. They loans may and be
able • Debts
to help
to you
central with
or
the local form
government
and give help and advice on any money Catalogues, other problems forms credit / of debt cards, non-secured issues personal you have. lending loans and
• Please departments do not forget e.g. to sign tax the and declaration national insurance
section 11 – if you do other not
• Holidays
sign forms it, we of non-secured cannot assess your lending application.
SENDING • Deposits IN to secure YOUR accommodation
APPLICATION Holidays
• Once • Medical completed equipment, the application aids form and should adaptations
be returned to:
FREEPOST RSRX-JHTT-AZSG, npower Energy Fund, PO Box 42, Peterborough, PE3 8XH
Please note: The Veolia Water Trust is administered by Charis Grants Ltd (Charis) along with a number of other
Please note: The npower Energy Fund is administered by Charis Grants Ltd (Charis) along with a number of other grant making
funds,
grant
see
making
www.charisgrants.com
funds. By signing
for details.
this form
By signing
you agree
this form
to your
you agree
information
to your information
being shared
being
with
shared
these
with these
other
other
grant
funds making for them funds to for consider them if to you consider are eligible if for you their are support. eligible for their support. A full list of grant making funds
administered by Charis can be viewed online at www.charisgrants.com

HOW WE DEAL WITH YOUR APPLICATION
• If we think that other organisations might be of interest to you, we may provide you with information about their
work or share your details with them so that they can contact you about their services and / or products.
• Your information may be used for research and analysis purposes by other organisations.
• You may receive letters, emails, telephone calls or a home visit as part of our assessment process.
• If we can help with your energy debts, we will write to tell you that a provisional award has been made. Your debt
will not be cleared immediately. During the three months following your provisional award you will be required
to demonstrate your commitment to improving your personal financial stability, i.e. your intention to pay current
and future costs on an ongoing basis and to avoid getting into debt in the future. Your commitment would be
demonstrated by:
• Payments towards your current usage and arrears while your application is being processed. This will
immediately show the Fund that you are currently financially stable. You may wish to talk to npower to set up
direct debit payments which are a more convenient way to pay and can help with monthly budgeting.
• Discussing with npower how you might reduce bills including whether any of their reduced tariffs would be
beneficial for you.
• If you have not already done so, seek help from expert money advisers or other free relevant support agencies to
help with future budgeting.
• Three months after the provisional award has been made, if it can be seen that you have taken steps towards
achieving financial stability, you will receive a letter confirming your award and a payment to npower will be made
to clear your debt.
• If you qualify for help from any other trust / fund administered by Charis (see www.charisgrants.com), your
application will be considered automatically. We might need to ask you for more information.
• If the Fund cannot help you we will write to tell you. Please note the Fund does not give particular reasons
why a grant is not awarded.
• The Fund receives many applications so it may take several weeks to process yours.
APPLYING TO THE FUND AGAIN
• If your application is successful and you receive an award from the Fund to clear your debt, you cannot re-apply
for a period of two years.
• If you are accepted onto the Fund’s Provisional Award Scheme but your award is not confirmed you can re-apply
six months from the date of the letter informing you of the Fund’s decision.
• If your application is unsuccessful and you are not accepted onto the Fund’s Provisional Award Scheme you can
re-apply if your circumstances change.
PAGE 2 MARCH 2013

FOR OFFICE USE Date received: Reference NPW:
APPLICATION FOR ASSISTANCE
SECTION 1 PLEASE TELL US ABOUT YOURSELF AND YOUR FAMILY
Did you obtain money / debt advice before applying to the Fund Yes No
If yes, name of money / debt advice agency
Title (Mr / Mrs / Ms / Other) First Name Family Name
Address
Postcode Telephone Email
Date of birth D D M M Y Y Y Y Tick here if you own your own home or you rent it from a private landlord
Who shares your home with you Tick all that apply:
Wife, husband, civil partner, partner
Children and/or young people 19 years
and under in full time education
Other adults over 16 years
No one, I live alone
Full name of wife, husband, civil partner, partner
How many Ages of children
How many
SECTION 2 WHAT WOULD YOU LIKE US TO HELP YOU WITH (PLEASE REFER TO PAGE 1)
I am applying for help with my: npower electricity debt npower gas debt
Do you require information on energy efficiency from your supplier Yes No
Telephone number for supplier to contact you:
SECTION 3 HAVE YOU APPLIED TO THIS FUND BEFORE
If you have applied to this Fund before, please tell us when you applied and from what address if this is different from your current address:
When Address Postcode
SECTION 4 HOW DID YOU HEAR ABOUT THE FUND
Utility Company Health Professional Housing Agency CAB Advice Agency
Support Worker Website Media Word of Mouth Other - please state
Please tick here if you are receiving money advice.
SECTION 5 WHO SHOULD WE SPEAK TO REGARDING THIS APPLICATION
You may be receiving help to complete your application. If you would prefer us to speak to someone else regarding your application - if more
information is needed and with progress - please give their details below. This may be a friend, relative, or advice agency, e.g. Citizens Advice
Bureau. If this section is not completed we will write directly to the applicant.
Their Name Mr/Mrs/Ms
Their job title
Their organisation
Their address
Postcode
Their telephone number
Their Email
Tick here if you authorise the Fund to speak to anyone at this organisation regarding your application.
MARCH 2013 PAGE 3

PLEASE GIVE US DETAILS OF RELEVANT ACCOUNTS AND UP TO DATE METER READINGS FOR GAS AND ELECTRICITY
Please note: Only complete rows in red type if applying for assistance from other grant making funds held by Charis.
View details online at www.charisgrants.com
Please note: Only complete rows in red type if applying for assistance from other grant making funds administered by Charis.
SECTION 6 IF YOU name WANT of supplier HELP View details WITH account online YOUR number at www.charisgrants.com
ELECTRICITY Present meter AND/OR reading GAS Date DEBTS of meter Read
Electricity
PLEASE
(current)
GIVE US DETAILS OF RELEVANT ACCOUNTS AND UP TO DATE METER READINGS
name of supplier account number Present meter reading Date of meter Read
Electricity (previous)
(current) Name of supplier Account Number Present meter reading Date of meter reading
Gas Electricity (current)
(previous)
Electricity (current)
Gas (previous)
(current)
Water Gas
Electricity (previous) (current) (previous)
Water Gas (previous) (current)
Sewerage Water (previous) services
(if Gas billed (previous) separately)
Sewerage services if
billed seperately We cannot assess your application until a present meter reading is given, unless you have pre-payment meter.
We
We
cannot
cannot
assess
assess If you your
your have application
application a pre-payment until
until a
present
present meter, please meter
meter tick reading
reading the appropriate is
is
given,
given,
unless
unless box(es): you
you
have
have gas ❑ pre-payment
pre-payment electric ❑ meter.
meter.
If
If
you
you
have
have a
pre-payment
pre-payment
meter,
meter,
please
please
tick
tick
the
the
appropriate
appropriate
box(es):
box(es):
gas
gas ❑
electric
electric ❑
Are any of these charges from a previous address (Please tick) Yes No Not sure If applying for help with debt from a previous
account If applying only, for please help with also debt provide from your previous current
Are If yes any or of not these sure, charges please from give your a previous previous address address(es): (Please tick) Yes No Not sure account
If applying account only,
for
please details help with
also in the debt
provide table from above. your
a previous
account
current
account
only, please
details
also
in the
provide
table above.
your current
account details in the table above.
Address If yes or not sure, please give your previous address(es):
Postcode
Address
Postcode
SECtion 7 PLEASE tELL US ABoUt YoUr HoUSEHoLD’S finAnCiAL SitUAtion
The only only alternative alternative to
to completing to completing Section
Section section 7
is
is
to
to
submit
submit 7 is to the
the submit budget
budget the sheets
sheets income from
from
the
the and MAT/BBA
MAT/BBA expenditure
budget Common sheet Financial ofStatement.
the maT/BBa Common Financial Statement Version 3 or 4 only
HouSEHoLD WEEKLY ExPEnDiTuRE
Common Financial Remember to include repayments from sections and in this column
HouSEHoLD WEEKLY inComE
Remember to include repayments from sections s8 and 9 in this column
Proof confirming income must be provided. See Section 13.
Proof confirming income must be provided. See Section 13.
Food and housekeeping £
Rent (including arrears if applicable) Rent £
Your take-home pay £
We cannnot accept monthly figures. Rent arrears (if applicable) Mortgage £
Partner’s take-home pay £
We cannnot accept monthly figures.
To change monthly figures to weekly:
Mortgage Second mortgage £
Income Support / Job-Seeker’s Allowance £
To change monthly figures to weekly:
1) Multiply by 12 (to give annual payment)
1)
Multiply by 12 (to give annual payment)
2) Divide the total by 52.
Endowment Second mortgage policy £
Working Tax Credit £
2) Divide the total by 52.
Council Council Endowment tax (after benefit) policy £
Child Tax Credit £
Council Water / Tax sewerage (after benefit) charges £
Pension Credit £
Water / sewerage charges State Pension £
Electricity £
Electricity Works Pension £
Gas £
Gas Employment & Support Allowance £
Other fuel (e.g. coal, oil) £
Other fuel (e.g. coal, oil) Disability Living Allowance: - care component £
Life / Building / Contents insurance £
School meals
- mobility component £
Tip: If If you you receive Disability Disability Living Living Allowance, Allowance, remember Telephone £
Tip: remember to show If you howreceive to you show spend Disability
how this you money Living
spend . Allowance, Whether this you use
Telephone Other disability benefits (please specify) £
remember money. it as partWhether ofto your show general how
you use living you spend
it as costs part orthis
of pay for a Carer, TV / Satellite £
TV Satellite Child Benefit B £
money. your medication, Whether
general transport you
living costs etc, use
or please it part
pay for make of
Carer, sure you show TV Licence £
your medication, this ingeneral the expenditure living costs
transport etc, column. or pay for a Carer,
please make sure
TV Licence Other benefits (please specify) £
medication, transport etc, please make sure
Child care £
you show this in the expenditure column.
Child care Child maintenance / support £
you show this in the expenditure column.
Life / Building / Contents
School
insurance
meals £
Contribution(s) from others living with you £
Car (loans / tax / fuel / repairs etc.) £
Car (loans tax fuel repairs etc.) Rent from lodger £
Work
Work
expenses
expenses
and
and
travel
travel
£
Local Housing Allowance / Housing Benefit / (please provide details in section 9)
£
Loans
Loans /
credit
credit +
store
store
cards
cards /
catalogues
catalogues
(please
(please
provide
provide
details
details
in
in
section
section
9)
9) £
Mortgage Interest Relief
(please provide details in section 8) County Court Judgements (CCJs) / Court fines (please
(please
provide
provide
details
details
in
in
section
section
8)
8) £
TOTAL Total £
(please specify) Expenses for disability (please specify) £
Other income e.g. from investment £
(please specify) Other expenses (please specify) £
Present value of savings and bank £
ToTaL accounts held
£
Comments:
Comments:
PAGE 4
SEPTEMBER 2012
PAGE 4 AUGUSt 2009
PAGE
PAGE 4 AUGUSt
AUGUSt
2009
2009
PAGE MARCH 2013

SECtion 8 ArE YoU in DEBt WitH AnY of tHE foLLoWinG BiLLS
Please tick all that apply and write in the amount you owe and the amount being repaid.
WEEKLY amounT REPaiD oR DEDuCTED
amounT oWED FRom BEnEFiTS oR WaGES
Rent £
£
Mortgage £
£
Second mortgage / secured loan £
£
Council Tax £
£
Water and sewerage £
£
Gas £
£
Electricity £
£
Telephone £
£
Social Fund Loan £
£
Benefit overpayment £
£
CCJs / Court fines £
£
Child Maintenance / support £
£
SECtion 9 LoAnS, CrEDit & StorE CArDS, CAtALoGUES EtC.
Name of creditor
Continue on a blank page if necessary.
Remember to include all repayments in section 7.
Remember to include all repayments in section 7.
Amount owed
£ £
£ £
£ £
£ £
£ £
£ £
£ £
£
£
IMPORTANT!
imPoRTanT!
–
–
Please
Please
read
read
carefully
carefully before
before
completing
completing
the
the
next
next
page
page
NAME OF SUPPLIER
Amount paid per week
fiLLinG FILLING in IN tHE THE nEXt NEXT PAGE PAGE
The next page is where you must explain how a payment from the Trust will help you.
The next page is where you must explain to us how a payment from the Fund will help you. In deciding whether to
In deciding whether to help you with debts the Trust will:
help you with your debt the Fund will:
• need to know how you got into difficulties with the particular debt. You should give as much detail as possible about how long you
have had problems in paying the bills and why.
• need to know how you got into difficulties with the particular debt. You should give as much detail as possible
about need to how be sure long that, you if the have Trust had does problems help you, you in will paying be able the to bills manage and to why. pay your bills in the future. This means that if, in section 7
you have more money going out than you have coming in, you should explain how you think you will be able to keep up with your bills
• need in future. to be sure that, if the Fund does help you, you will be able to manage to pay your bills in the future. This
means need to that know if, about in section any particular 7 you hardship have more within money your household going out e.g. than chronic you illness, have disability, coming bereavement. in, you should Where explain possible how
you evidence think must you be will provided. be able to keep up with your bills in future.
to know what might happen to you if the debt is not paid e.g. could you be evicted or your fuel supply be disconnected
• need to know about any particular hardship within your household e.g. chronic illness, disability, bereavement.
In deciding Where whether possible to evidence help you with must one-off be provided. items such as domestic appliances, the Trust will:
to know exactly what you want and how having the item essential to your needs.
• need to know what might happen to you if the debt is not paid, e.g. could you be evicted or fuel supply
disconnected
need to know about any particular hardship within your household e.g. chronic illness, disability, bereavement.
• need supporting evidence from an appropriate professional confirming exceptional need exists for the item requested.
MARCH 2013 PAGE 5

SECTION 10 WHY DO YOU WANT HELP WITH YOUR UTILITY DEBT
Please tell us the problems you have had which have made it difficult for you to pay your gas and/or electricity bills. Give as much detail as
possible. See guidance notes in section 13, ‘Your most recent utility bill’, for details of supporting documents needed. Continue on a
blank page if necessary.
SECTION 11 HOW WOULD A PAYMENT FROM US HELP YOU BUDGET BETTER
IN THE FUTURE
Please tell us how a payment from us would help you budget better in the future, and how you intend to make payments towards your
ongoing usage.
PAGE 6 MARCH 2013

SECTI0N 12 DECLARATION TO BE SIGNED BY THE APPLICANT
By signing this form, I consent to the personal information I have provided on this form and in support of my application being:
(1) Shared with my Utility Company in relation to my account and the services provided by them.
(2) Processed by Charis Grants Ltd in accordance with the Data Protection Act and as described in the ‘How we deal with your application’ section on the
front cover of the application form.
If I have provided personal information about any other person (e.g. my partner) in support of this application, I confirm that I have obtained consent from
that person to the use and sharing of that information, as described above.
I authorise Charis Grants Ltd to contact me directly about my application and declare that the information I have given on this form is complete and correct
to the best of my knowledge.
I declare that in applying to the Fund I am committed to achieving future financial stability allowing me to keep up to date with current bills and avoiding
getting into debt in the future. I understand that awards will only be granted to applicants who demonstrate their commitment to improving their own
personal financial stability.
To this aim I have sought money / debt advice (if appropriate) and am confident that I am receiving my full benefit entitlement.
I wish to be considered for any additional funds, either administered by, or identified by Charis Grants Ltd that I am eligible to apply for.
I understand that the decisions of the Fund are final and that there is no appeals procedure.
Please tick the box to confirm the above declaration.
Signature Print name Date
SECTION 13 FILLING IN THE APPLICATION FORM
Please make sure you enclose items on the checklist below with your application. All evidence excluding annual benefit letters for Works Pension /
State Pension / DLA / Child Benefit must be less than 3 months old. Please provide copies of all documents supporting your application as we do not
return originals.
Proof of income
You must provide proof with your application of income figures detailed in section 7 including:
• The current amount of net wages received by you and any partner
• The current amount of all benefits and pensions received by you and any partner
• The current amount of child maintenance / support received by you and any partner
Wages: copies of 3 recent consecutive wage-slips for you and any partner. If you or your partner cannot provide wage-slips, please get a letter from the
employer giving your recent average net pay.
Self employed applicants should send in recent three line accounts or another document confirming net income. We just need to know the month, the
money earnt during that month, allowable expenses and the net profit.
Benefits and Pensions:
• copies of current benefit, Tax Credit or pension payment slips or giro details showing amounts currently payable, or
• copies of bank statements showing current benefit, Tax Credit or pension payments or
• copies of recent letters from the Department for Work and Pensions (DWP), HM Revenue and Customs (HMRC) or pension provider showing amounts
currently payable.
If none of these are available, please obtain a letter from the DWP, HMRC or pension provider confirming the amount of your benefit, Tax Credit or pension
entitlement.
Child Maintenance / Support: a copy of a recent letter from the Child Support Agency or a recent bank statement showing the amount payable to you or
your partner or another letter or document confirming the current amount being paid.
Your most recent utility bill (and a meter reading entered in section 6)
If you are asking for help with gas and electricity debts, please provide us with copies of your most recent gas and/or electricity bill. If you are also applying
for help from other trusts administered by Charis then you must also attach copies of the most recent bill or details of actual meter readings (not estimated)
that are relevant to your application (see section 6).
Evidence of disability or other illness
If you are relying on a disability or illness as proof of hardship or need, please attach some independent evidence which confirms your medical condition:
for example, a copy of a current sick certificate or a letter from your GP / consultant to a third party confirming your condition. Please note that the Trust is
unable to meet the cost of obtaining medical evidence.
Please note that we cannot assess your application until all necessary supporting evidence is provided.
MARCH 2013 PAGE 7

ENERGY EFFICIENCY ADVICE FROM npower
For advice on how to use less energy and reduce bills,
call npower’s energy efficiency helpline free on:
0800 02 22 20
This service is available from Monday to Friday (8am until 6pm) and Saturday (9am until 5pm)
APPLYING TO THE FUND AGAIN
• If your application is successful and you receive an award from the Fund to clear your debt, you cannot re-apply for a period
of two years.
• If you are accepted onto the Fund’s Provisional Award Scheme but your award is not confirmed you can re-apply six months
from the date of the letter informing you of the Fund’s decision.
• If your application is unsuccessful and you are not accepted onto the Fund’s Provisional Award Scheme you can re-apply if
your circumstances change.
MONITORING INFORMATION (THIS PART WILL BE DETACHED BEFORE ASSESSMENT)
Please tick as appropriate
Are you Female Male
Are you registered disabled Yes No
What do you consider your ethnic origin to be
WHITE
British Irish Any other White background
MIXED
White & Black Caribbean White & Black African White & Asian Any other Mixed background
ASIAN OR ASIAN BRITISH
Indian Pakistani Bangladeshi Any other Asian background
BLACK OR BLACK BRITISH
Caribbean African Any other Black background
CHINESE OR OTHER ETHNIC GROUP
Chinese
Any other Ethnic Group
Charis Grants Ltd. provides independent management of the npower Energy Fund.
PAGE 8 MARCH 2013