Application form for support

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Archibald Riley
6 years ago
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1 for support In the name of Allah, the most beneficent, the most merciful About filling in this form Please use black ink to fill in the form. If you make a mistake, just cross it out and put the right answer next to it. Answer Yes or No questions by ticking the relevant box. If you are picking an answer from a list of answers, put a tick in the relevant box. Please read all the information and notes in the form. Please use the checklist on page Please provide photocopies originals will not be returned.... PLEASE REMEMBER TO SIGN AND DATE THE DECLARATION.... r information and proof of documents must be correct and complete.... Once completed, you can either scan and or post the form to us; details can be found on page 11. Please note that sending an incomplete application or omitting supporting documentation is likely to delay the process considerably. Processing the form and decision If you have provided all relevant and requested documentation, we will aim to acknowledge your application within 3 days insha Allah. The processing time will depend on urgency of the case. During this time, we may contact you by phone or by to request further information or clarification. Please ensure that you respond to the queries and s that are sent to you. What next? Once we receive your application, you will be assigned a caseworker. will be contacted by your caseworker for further queries. They will complete a case report that will be submitted to our Zakat panel who will determine eligibility and approve funds if applicable. We will then notify you about our decision. Please note we rarely distribute cash payments to applicants. For example, our support may be in the form of food vouchers or direct payments to creditors and/or landlords where relevant.... Allah (SWT) says in verse 153 and verses of Surah al-baqarah: O you who believe! Seek help through patience and prayer. Truly, Allah is with the patient ones And certainly, We shall test you with something of fear, hunger, loss of wealth, lives and fruits, but give glad tidings to the patient ones. Who, when afflicted with calamity, say, Indeed to Allah we belong and indeed to Him we shall return. They are those on whom are the blessings and mercy from their Lord, and it is they who are truly guided. The Shari ah accuracy and appropriateness of this application form have been verified by the Al-Qalam Shari ah Panel - Page 1

2 Part 1 About you and your partner r Partner Surname First name(s) Title (Mr, Mrs, Miss, Ms) Age Date of birth Marital Status Religion Nationality What is your legal status? Languages you can speak, please list: How many years have you lived in the UK? Address including postcode How long have you been living at this property? Telephone number (Mobile and home) address Are you currently in employment? Do you own your property? If you do not own a property, please describe your type of accommodation? E.g. council housing, housing association, private rental etc. Page 2

3 Part 2 About any children who live with you Please provide proof of ID for all children listed below, in the form of a birth certificate or passport copy. If no children live with you go to Part 3. Surname First name (s) First Child Second Child Third Child Fourth Child Date of birth Age Gender Do you get any child benefit or child tax credit for them? Please describe Part 3 About family members and/or dependents who live with you Surname First name (s) Person 1 Person 2 Person 3 Date of birth Gender Relationship to you Are you financially responsible for them? Do they get an income (from employment, benefits etc)? Please provide details. Page 3

4 Part 4 r Assets r Partner Gold (in grams) Silver (in grams) Do you have a bank account Yes No Yes No How many accounts do you have? Please provide balance for each account: Cash in Hand Account 1 Account 2 Account 3 Any other investments Property (in addition to your home) including property aboard Money owed to you by any third party debtor (if anyone owes you any money please also state when it is due to be paid) Page 4

5 Part 5 - Outstanding Debt Please provide all relevant documentation as evidence. r Partner 1. Bank Overdraft Name of lender Credit Cards Name of lender Store Cards Name of lender Personal Debts Name of lender Other (please describe) Name of lender TOTAL Page 5

6 Part 6 About your income No income from any source Tick Box Please state the amount PER MONTH (figures should reflect reality of last 3 months) r Partner Employment income Self-employment income Working tax credit Child Benefit Child Tax Credit Universal Credit Employment and Support Allowance Housing Benefit Income Support Jobseekers Allowance Pension credit Personal Independence Payment Asylum/ NASS Support No recourse to public funds support Investment income Rental income Support from any other charities Other (please describe) TOTAL MONTHLY INCOME Page 6

7 Part 7 About your expenses Please state the amount PER MONTH r Partner Rent Mortgage Gas Electricity Water rates Council tax Food Transport costs (inc. petrol/insurance if relevant) Telephone (landline)/broadband Telephone (mobile) TV license TV satellite Loan repayment Baby/child related expenses Other (please describe) TOTAL MONTHLY EXPENSES Total Household Income Part 8 Have you applied to any other organisations for support? Name of organisation Case number & contact person Amount of funding/support requested Page7

8 Part 9 About any disabilities r Partner Are you disabled? Yes No Yes No Do you receive a Personal Independence Payment? If yes, please state amount in Part 6 Yes No Yes No Description of disability (please provide evidence) Part 10 Referees Please note referees cannot be family members. It is preferred if these references are from a professional e.g. your keyworker, GP etc. Name Address Referee 1 Referee 2 Postcode Telephone Relationship with applicant Number of years known to applicant Page 8

9 Part 11 Please explain your situation & how you would like NZF to help you How did you hear about NZF? Part 12 Previous applications Have you previously applied for support from NZF? Yes No If Yes, please state the date of your application and your previous application number below. Date of previous application Previous application number Please note you may only reapply on the basis of new or exceptional circumstances. Page 9

10 Page 10 Declaration I testify in front of Allah (SWT) that the information provided on this form is true and accurate to the best of my knowledge. I testify that I am not submitting a fraudulent application and that I am genuinely in need of support. I agree that the information provided in this application will be utilised in connection with this request for Zakat. I understand that my personal information will remain private and confidential and that any sharing of information will be limited for the purposes of processing my application. I also give consent to National Zakat Foundation to make reasonable enquiries relating to my application. Should my application be successful then I consent to National Zakat Foundation receiving and disbursing Zakat funds on my behalf in a manner that the organisation sees fit and in line with the needs highlighted in my application. r Partner Name Signature Date MUST SIGN AND DATE APPLICATION OR APPLICATION WILL NOT BE PROCESSED.

11 The following is a list of documents you must provide where relevant: ID for main applicant and your partner - passport/drivers license (Part 1) ID for all children birth certificate or passport (Part 2) Debt related documentation (Part 5) Documents illustrating benefits (Part 6) Proof of earnings (e.g. last three months payslips) Itemised bank statements (last three months) Proof of address (utility bill/council tax bill) Tenancy agreement UKBA documents describing status if you are on a visa, a refugee or an asylum seeker Any other relevant documentation Please only provide photocopies as originals cannot be returned. Please note that sending an incomplete application or omitting supporting documentation is likely to delay the process considerably. If you are unable to provide any of the required information for a valid reason, please continue to submit your application but do explain why you have been unable to supply the relevant documents. Once completed, you can scan the form and documents then to: apply@nzf.org.uk OR POST the completed form and certified documents to: Zakat Centre, National Zakat Foundation, 41 Fieldgate Street, London E1 1JU or if you are unable to cover the cost of a stamp to: FREEPOST NZF (although this may take longer to reach us). If you have any queries please send us an at the address above. In case of an emergency please call: Page 11

Council Tax Benefit or Second Adult Rebate claim form for homeowners

Name: Address: Postcode: Revenues and Benefits Council Offices South Street Rochford Essex SS4 1BW Phone: 01702 318197 or 01702 318198 E-mail: revenues&benefits@rochford.gov.uk Council Tax Benefit or Second