Application form - Glover's Trust

Please fill in and submit First Applicant details before filling-in and submitting Second Applicant details

Company

This field is for validation purposes and should be left unchanged.

FIRST APPLICANT(Required)

ABOUT YOU

Name(Required)

First Last

Date of birth(Required)

Place of birth(Required)

Marital Status(Required)

If widowed, when did your husband/wife die?

Address(Required)

Address 1 Address 2 Town/City County Post Code Country

Home Phone(Required)

Mobile Phone(Required)

Email(Required)

How long have you lived there?(Required)

Are you the owner or a tenant?(Required)

Does any member of your family have a financial stake in your property?(Required)

Yes

Previous Address(Required)

Address 1 Address 2 Town/City County Post Code Country

How long did you live there(Required)

Number and ages of children(Required)

Are you retired or working?(Required)

If retired, what was your occupation?(Required)

Have you applied for a Glover’s cottage previously and if so, when?(Required)

Please give details of any health issues(Required)

Name of Doctor(Required)

Address of Doctor(Required)

Address 1 Address 2 Town/City County Post Code Country

Do you own a car?(Required)

Yes

If yes, please give make, model and age(Required)

Do you smoke or vape?(Required)

Yes

Do you have a will?(Required)

Yes

Do you have any current, unspent convictions?(Required)

Yes

If yes, please give details(Required)

FIRST APPLICANT: weekly income

State pension £(Required)

Housing Benefit £(Required)

Other benefits £(Required)

Please specify(Required)

Private pensions £(Required)

Other income £(Required)

Please specify(Required)

Total weekly income £(Required)

What are your weekly payments for rent/mortgage? £(Required)

Your savings and assets

National savings £(Required)

Bank account £(Required)

Other savings £ eg ISAs(Required)

Investments £(Required)

Value of property £(Required)

Moving to Glover’s

Why do you wish to move to Glover’s?(Required)

References

Please give details of two people who are not your relatives that we can ask for a reference about you. If you are applying as a couple, the people you list should ideally know you both. If not, please provide details of someone for each of you, listing the first applicant’s referee as number 1.

Reference 1

Name(Required)

First Last

Address(Required)

Address 1 Address 2 Town/City County Post Code Country

Phone(Required)

Email(Required)

Reference 2

Name(Required)

First Last

Address(Required)

Address 1 Address 2 Town/City County Post Code Country

Phone(Required)

Email(Required)

General Data Protection Regulation

COMMON REPORTING STANDARDS COMPLIANCE (CRS) In order to deal with your application, it is necessary for the Trust to keep a file containing information about you. Under the terms of Company Reporting Standard legislation (CRS), introduced in 2017, the Trust is now obliged, by law, to provide HMRC with certain information regarding the tax residence of grant applicants who receive assistance from the Trust and the following information is required:

Country of Residence for Tax Purposes: UK or OTHER(Required)

Other

If OTHER, please specify Jurisdiction(Required)

Tax ID or National Insurance Number(Required)

Date of Birth(Required)

HOW WE USE THE INFORMATION YOU HAVE PROVIDED

The information you have provided, will only be used to process your application. Your information will be stored on computer, in paper format or in other ways being used by the Trust for the purpose of processing your application. Your information will only be shared with Trustees of the Trust and will not be shared with any third parties and will be destroyed securely, once the process has concluded. The Trust may make enquiries relating to your application. You are entitled to request a copy of the details held by the Trust about you. For further information on the Trust's Privacy Notice, please go to: https://glovers-trust.org You may have included personal information within your application. If so, you are responsible for confirming you have the written agreement and permission of any individuals identified in your application to pass their personal information to the Trust. The Trust will use this information only for the purposes of assessing your application.

Declaration and consent(Required)

I agree to the statements below.

Please read the paragraphs above and below, and then sign to show that you understand and
agree with them.
I declare that the information I’ve given is true to the best of my knowledge and belief, and
that I have answered all the questions that apply to me.
I give Glover’s Trust permission to use, share and store information I give:
• to make relevant checks to deal with my application; and if I move to Glover’s
• to support my wellbeing and care management while living there.

Name(Required)

First Last

Date(Required)

Name

This field is for validation purposes and should be left unchanged.

SECOND APPLICANT

ABOUT YOU

Name

First Last

Date of birth

Place of birth

Marital Status

If widowed, when did your husband/wife die?

Address

Address 1 Address 2 Town/City County Post Code Country

Home Phone

Mobile Phone

How long have you lived there?

Are you the owner or a tenant?

Does any member of your family have a financial stake in your property?

Yes

Previous Address

Address 1 Address 2 Town/City County Post Code Country

How long did you live there

Number and ages of children

Are you retired or working?

If retired, what was your occupation?

Have you applied for a Glover’s cottage previously and if so, when?

Please give details of any health issues

Name of Doctor

Address of Doctor

Address 1 Address 2 Town/City County Post Code Country

Do you own a car?

Yes

If yes, please give make, model and age

Do you smoke or vape?

Yes

Do you have a will?

Yes

Do you have any current, unspent convictions?

Yes

If yes, please give details

SECOND APPLICANT weekly income

State pension £

Housing Benefit £

Other benefits £

Please specify

Private pensions £

Other income £

Please specify

Total weekly income £

What are your weekly payments for rent/mortgage? £

Your savings and assets

National savings £

Bank account £

Other savings £ eg ISAs

Investments £

Value of property £

Moving to Glover’s

Why do you wish to move to Glover’s?

References

Reference 1

Name

First Last

Address

Address 1 Address 2 Town/City County Post Code Country

Phone

Email(Required)

Reference 2

Name

First Last

Address

Address 1 Address 2 Town/City County Post Code Country

Phone

Email(Required)

General Data Protection Regulation

Country of Residence for Tax Purposes: UK or OTHER

Other

If OTHER, please specify Jurisdiction

Tax ID or National Insurance Number

Date of Birth

HOW WE USE THE INFORMATION YOU HAVE PROVIDED

Declaration and consent(Required)

I agree to the statements below.

Name

First Last

Date