Digital Devices Request Form

Digital Devices Request Form

Please fill out the following information to request a Data SIM card. For more information, visit our website: www.accessbridge.net
Terms and Conditions for Requesting a Digital Device and Data SIM

Access Bridge supports individuals by providing both Data SIMs and Digital Devices to those in need. Applicants are welcome to apply for both; however, each successful applicant will only be eligible to receive one Data SIM and one Digital Device. The allocation is subject to availability, and applications will be assessed on a case-by-case basis to ensure fair distribution. Data SIMs come with a predefined data allowance, and recipients are responsible for managing their usage within these limits.

By accepting a Data SIM and/or Digital Device, recipients agree that these items are for personal use only and must not be sold, transferred, or misused. Access Bridge reserves the right to review applications, request supporting documentation, and decline or withdraw support if any terms are breached. By submitting an application, individuals confirm that they meet the eligibility criteria and accept these conditions.
Full Name*

First NameLast Name
D.O.B*
Gender*

MaleFemaleNon BinaryPrefer Not Say
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Delivery Address*

Street Address

Street Address Line 2
CityBoroughPost Code
Nationality*
Immigration Status (select one):*

Asylum SeekerRefugeeUK CitizenOther
Preferred Language:
Do you currently have access to the internet?*

YesNo
Preferred Digital Device*
Why do you need a Digital Device ? (Check all that apply)*

To access online learning resourcesTo apply for jobs and training opportunitiesTo access health and welfare services
Are you receiving any other digital support (e.g., from a charity or local council)?

YesNo
DECLARATION & CONSENT

Agreement & Acknowledgment
I confirm that the information provided in this form is accurate. I understand that the Data SIM card is provided for personal and essential use only, and I agree to use it responsibly. I acknowledge that Access Bridge has the right to review and reassess my eligibility for continued support.
Signature*

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Date*

MonthDayYear
Date
Data Protection & Consent

Access Bridge will process your data in accordance with GDPR and privacy regulations. Your information will only be used for the purpose of evaluating your request and providing digital support.
I consent to Access Bridge processing my personal data for this requestI agree to be contacted for follow-up and impact assessment
Signature*

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Date*

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