MARTHAM BOAT DYKE TRUST (MBDT)

MARTHAM BOAT DYKE TRUST (MBDT)
Application Form for Grants to Individuals

Your completed form should be emailed to mbdtclerk@gmail.com or posted to The Clerk to the Trustees, 2 Marten Close, Staithe Road, Martham NR29 4FG. Mobile Telephone No: 07385 907396

If you need more space for your answers, please attach extra pages.
Date of application

Month Day Year
Date
Name of person making this application
Address
Telephone number
Mobile number
E mail address
example@example.com
Who will receive or benefit from the grant?
What is the grant to be used for?
What difference will the grant make?
Are you anticipating funding from any other source?
YES / NO If YES please give details
Total amount requested
Total cost of item/activity
Please advise the contact details of an individual/referee or mentor who can provide background information on the circumstances for the application
Clerk to the Trustees, 2 Marten Close, Staithe Road, Martham. Great Yarmouth. NR29 4FG Mobile Telephone No: 07385 907396
MARTHAM BOAT DYKE TRUST (MBDT)
Have you previously applied for a grant from the MBDT?

YES / NO If YES please give details

Please note that when a grant is made the Trust will require proof of purchase.

Send this form and the supporting documents to: mbdtclerk@gmail.com or post to: The Clerk to the Trustees, 2 Marten Close, Staithe Road, Martham NR29 4FG. Alternatively the MBDT can be contacted on Mobile Telephone No: 07385 907396.

have answered all the questions to the best of my knowledge. If circumstances change during the application process / will inform the Trust at once.
Signature of applicant

Clear
Date

Month Day Year
Date
Applications from individuals for small grants will be reviewed by a Case Officer who is a Trustee of Martham Boat Dyke Trust. They will make direct contact with you.

Note: It is a condition of the Trust that any unused portion of a grant should be returned to the Trust.

The information you have provided about yourself will be held securely. We will not pass this on to anyone else without your consent and will only use it to provide you with the service you have requested Some anonymised information on successful applications may be used in the Trust's accounts which may be published. Individuals will not be identified You can contact Martham Boat Dyke Trust to request to see the information held by us or to ask for it to be erased.

For office use only Date application received by Martham Boat Dyke Trust
Date application received by Martham Boat Dyke Trust

Month Day Year
Date
Funding agreed/declined
Amount awarded
Cheque number
Receipt received
Clerk to the Trustees, 2 Marten Close, Staithe Road, Martham. Great Yarmouth. NR29 4FG Mobile Telephone No: 07385 907396
Should be Empty: