Cottenham Charities Christmas Voucher 2024 Application Form

COTTENHAM CHARITIES
Christmas Voucher Scheme 2024 - Application Form
Name of Applicant*

TitleFirst NameSurname
Date of Birth*

DayMonthYear
Applicant Date of Birth
Name of Spouse/Partner
Date of Birth

DayMonthYear
Spouse/Partner Date of Birth
Address*
Postcode*
Phone Number*
In case we need to contact you (NO spaces)
Email Address*
Number of years of residence in Cottenham*
Numbers only
How many children do you have aged 16 or under?
Numbers only
Child 1 - Name
First Name
Child 1 - Age
Child 2 - Name
First Name
Child 2 - Age
Child 3 - Name
First Name
Child 3 - Age
Child 4 - Name
First Name
Child 4 - Age
I wish to apply for a Christmas voucher from the Trustees of the Charities. I confirm that I am a permanent resident of the Parish of Cottenham, this is the only application from my household and I/we receive the following benefit(s) (please tick):*

Pension CreditPension Savings CreditIncome SupportIncapacity BenefitEmployment and Support Allowance - Work relatedEmployment and Support Allowance - SupportHousing Allowance/BenefitCouncil Tax Support (not 25% discount)Universal Credit
Signed*
Just type your name in this box
Date*

DayMonthYear
Date
Please ensure you have available evidence of the Benefit(s) you have ticked above to show to the person that visits you to deliver the Christmas Voucher.

Application Forms must be submitted no later than 4.30pm on Wednesday 11th December 2024

Information on benefits, supplemental income and pension credits is available from www.gov.uk or Citizens Advice www.cambridgecab.org.uk or call 0808 278 7808
Should be Empty:

COTTENHAM CHARITIES

Christmas Voucher Scheme 2024 - Application Form