Wiltshire Household Support Fund and Surviving Winter Fund

Wiltshire Household Support Fund and Surviving Winter Fund
You will need to attach evidence in order to submit your application. Please have this ready before you complete the form.

You need to provide the following pieces of evidence:
- A PDF download or photo of your paper-copy bank statement which clearly shows your name and address which matches your provided address, dated within the last three months.
  OR a PDF download or photo of your latest paper-copy benefit award letter which clearly shows your name and address which matches your provided address.
  
  AND
- A PDF download or photo of your most recent paper-copy energy bill which clearly shows your name and address which matches your provided address.
  OR a photo of your prepayment meter, with meter number visible and the screen with the remaining credit left on the meter.
If you are applying for the Surviving Winter Fund, you will need to provide evidence of your eligible health condition. This can include:
- Recent prescription slip with name and address.
- Picture of medication packet with name and address.
- Recent GP/hospital letter with name and address.
- Latest Personal Independance Payment/ Disability Living Allowance/ Attendance Allowance benefits letter with name and address.
Please note we DO NOT accept screenshots.

Evidence is required otherwise the application will be delayed.
I would like to apply for financial assistance
You can only apply if you live in Wiltshire. Your application will not be processed if you live outside of that area.

The following must apply to you or someone in your household to be eligible for financial assistance.
- Receive means tested benefits OR
- Household income under £32,000 for a family or under £25,000 for a single person.
- Budgeting shortfall (liable to run up debt/not heat home/not eat)
- Health benefits or a health condition made worse by cold (this only applies for those applying to the Surviving Winter Fund)
Please confirm your understanding and eligibility of the scheme by clicking the below. By ticking the box you also consent to CSE storing your data for the purposes of issuing the grant*

I understand and qualify for this funding, and agree to CSE storing my data. For further information about how data is stored, please see our privacy policy: https://www.cse.org.uk/how-we-use-your-information/.

Your address (Write the first line of your address and your postcode). You must include your house number, and the address must match the evidence you provide. *
Name*

TitleFirst NameLast Name
Mobile Number*
Please enter a valid mobile phone number if available as this will allow us to text you your vouchers. If no mobile is available you can enter a landline number.
Email*
If you DO NOT have an email address, please enter none@none.com
Date of birth*

DayMonthYear
Date
Tenure*
How many adults live in the property?*
How many children under the age of 18 live in the property?*
Who is your Electricity and Gas Supplier if applicable?*
How do you pay for your energy bills?*

Pay as you go (with a card and/or key or app for your prepayment meter)Once a month by direct debitPay when you receive a billPay supplier directly (eg gas bottles, oil, biomass)Taking your bill to the post office
Does anyone in the household have a health condition worsened by the cold?*

YesNo
Please describe your health condition. Please note that evidence will be required to submit your application*
How do you heat your property?*
How do you heat your property?*

Please provide the following pieces of evidence:
- A PDF download or photo of your paper-copy bank statement which clearly shows your name and address which matches your provided address, dated within the last three months.
  OR a PDF download or photo of your latest paper-copy benefit award letter which clearly shows your name and address which matches your provided address.
  
  AND
- A PDF download or photo of your most recent paper-copy energy bill which clearly shows your name and address which matches your provided address.
  OR a photo of your prepayment meter, with meter number visible and the screen with the remaining credit left on the meter.
If you are applying for the Surviving Winter Fund, please provide evidence of your eligible health condition. This can include:
- Recent prescription slip with name and address.
- Picture of medication packet with name and address.
- Recent GP/hospital letter with name and address.
- Latest Personal Independance Payment/ Disability Living Allowance/ Attendance Allowance benefits letter with name and address.
Please note we DO NOT accept screenshots.

Evidence is required otherwise the application will be delayed.
Upload bank statement or benefits award letter here. *

Cancelof
Upload energy bill here OR a photo of your prepayment meter, clearing showing the meter serial number and remaining credit. *

Cancelof
Upload evidence of health condition here (for Surviving Winter Fund only)

Cancelof
If there is any other information you feel is relevant to your application, please state below:
Please note:

If you do receive food shopping or prepayment meter vouchers, they will be sent via Evouchers, a voucher distribution platform, please look out for emails from no-reply@evouchers.com. Once you have received an email regarding your voucher please redeem this as soon as possible. Each email will contain a voucher, so you might get more than one. It’s easy to do, for additional guidance click here to view a helpful guide on how to redeem your voucher. The Evouchers platform can be accessed via the app or online.

For questions relating to accessing or using your voucher, you can view some helpful FAQ’s here or contact the Evouchers support team on support@evouchers.com.

If you receive a payment to your energy supplier, please check with them that your account has been credited.
Should be Empty: