Welfare Assistance

RSPCA Llys Nini Voucher Request Form

RSPCA Llys Nini, as part of its objectives, is to provide support for animal welfare. We can offer some support for animals whose owners cannot afford medical care for their pets and who are on low incomes.
THIS FORM IS TO BE COMPLETED IN LIAISON WITH THE YOUR VET
Clients Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

City

Post Code
Mobile Number*
Email*
If you do not have an email address type - NA@NA.COM

Are any of your pets insured?*

YesNo
If yes, please tell us the name of your insurer
Are you the legal owner of pet(s) named on this application?*

YesNo
Have you applied for any other vouchers in the past 12 months for any of your animals?*

YesNo
If yes, have you applied for a voucher for this animal in past 12 months?*

YesNo

Nature of complaint of animal*
Please provide a summary of the nature of the health issue. (Please note the scheme does not cover routine treatments such as worming/de-fleaing, neutering or vaccinations)
Estimated cost of treatment*
Branch contribution (50% of treatment to a maximum of £75.00)

To be completed by the recipient of this voucher:

Application to receive support for veterinary treatment at RSPCA Llys Nini:
Every application will be looked at on a case by case basis and will not be automatically funded. The recipient is in receipt of means tested benefits, low income - See List (Proof will need to be uploaded)

All personal information supplied by you on this application form will only be processed by the RSPCA Cardiff to Swansea branch whose privacy policy is available and published at: www.rspca-llysnini.org.uk/privacy-notice.php
Please upload proof of benefit here*

Browse Files

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Clients e-Signature*
Type name here
Date*

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Date
Should be Empty:

RSPCA Llys Nini Voucher Request Form