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Household Support Fund online Form

1. The Household Fund is to assist residents most in need, in the Preston area, to help with significant rising living costs. It is intended to help those who do not have enough resources to meet immediate short term needs and require assistance with essential items over the coming months.
  
  It can help with:
  
  Energy and Water
  
  Food
  
  Essentials linked to energy and water
  
  Wider essentials linked to the cost of living increases.
  
  It is not intended to cover debt advice or general financial hardship support which is not linked to energy and water, food, essentials linked to energy and water.
  Housing costs will only be considered in exceptional circumstances as there are other benefits and support available to help with these, for example Discretionary Housing Payments.
  
  All applications must be supported with bank statements for all adults in the household and for all accounts held.
  
  Bank statements must be for one full calendar month, showing transactions in and out of the account, the balance, name and address, account number and must be dated within the last 2 months
  
  Screen shots showing the bank account details only, will not be accepted but pictures of bank statements may be submitted but must show the above
  
  If applying for help with utilities such as gas, electric and water then the most recent statement from your supplier MUST be attached showing your provider, account details and any arrears or credit on your account.
  
  If we do not have this information your application will not be considered.
  Please ensure you have read our Household Support Fund information page before applying.
2. Do you live in Preston?*
  
  Yes
  
  No
3. Are you completing this form for yourself or on behalf of somebody?*
  
  Completing the form for myself
  
  Completing the form for someone else
4. Your details
  1. Full Name
  2. Address line 1
  3. Address line 2
  4. Town/city
  5. Postcode
  6. Telephone number
  7. Email address
  8. Date of Birth
  9. Do you receive state pension or pension credit?
    
    State pension
    
    Pension credit
  10. National Insurance Number
  11. Are you (the Applicant) liable for Council Tax at the address given above?
    
    Yes
    
    No
    
    If Yes we will use your details to verify that you live in the City of Preston.
  12. Please provide your Council Tax reference number (if you need help with Council Tax Arrears it is vital that you provide your reference number)
5. About the person completing this form and the applicant
  1. Your full name completing this form
  2. The applicants full name
  3. The applicants Address line 1
  4. The applicants Address line 2
  5. Town/city
  6. The applicants Postcode
  7. The applicants Date of Birth
  8. The applicants National Insurance Number
  9. If the applicant gives you permission, please include there contact details as well as your own, just in case we need to contact you for further information.
  10. Your telephone number
  11. Your email address
  12. The applicants telephone number
  13. The applicants email address
  14. Is the applicant liable for Council Tax at the address given above?
    
    Yes
    
    No
    
    If Yes we will use your details to verify that you live in the City of Preston.
  15. Please provide your Council Tax reference number
  16. Relationship to applicant
  17. Agency you work for (if applicable)
6. Is anyone in the household an Armed Forces Veteran
  
  Yes
  
  No
7. Is anyone in your household registered disabled?
  
  Yes
  
  No
8. Do they receive a qualifying benefit?
  
  Yes
  
  No
9. Do you have caring responsibilities?
  
  Yes
  
  No
10. Do you receive Carer's Allowance?
  
  Yes
  
  No
11. Are you a care leaver?
  
  Yes
  
  No
12. Does anyone else live with you? *
  
  Yes
  
  No
13. Including yourself, how many adults live in the property?
14. Is anyone in the household of pension age? (Please answer yes or no)
15. Is there anyone in the household aged 19 - 25 with Special Educational Needs?
  
  Yes
  
  No
16. How many people in the household aged between 19 - 25 years have special educational needs?
17. How many children aged between 0 - 19 live in the property
18. How old is your child
19. How old is your child
20. How old is your child
21. How old is your child
22. How old is your child
23. How old is your child