Please read through the application and complete thoroughly. In order for us to use the Household Support Grant funding we require all the information requested on this form. Applications will be processed within 3 working days.

Applicant details

According to the Equality Act 2010, a disability is defined as a physical or mental impairment that has substantial and long-term effect on a person's ability to do normal daily activities.
Advisor, please ensure you capture the complete household.
Please include expected payment dates
Please include expected payment dates
If the customer has not agreed to the application, we are unable to continue with the request.