WELFARE FUND APPLICATION FORM DATA PROTECTION & PRIVACY NOTICE The Equity Charitable Trust takes your privacy seriously and will only use your personal data in order to process your application. If we are not able to help, we would wish to discuss the information in your application with other charities who may be better placed to help you. If you wish us to use your personal information, please ‘opt in’ by ticking the box, otherwise we cannot process your application. The sensitive details you have provided will be kept confidential. The Equity Charitable Trust will never sell your information or use it for any other purpose than in relation to your application. The Equity Charitable Trust will only process your data for the purpose of this application and will not provide information to any third party for reasons others than those described above without your consent. If you wish to withdraw your consent, you may do so in writing to the Secretary at which point your data will be destroyed. From time to time, we would like to alert you with news of events or workshops which may be of interest. If you wish to be contacted, please tick your preferred method of communication. EMAIL □ POST □ OPT IN □ I understand that the Equity Charitable Trust will hold my personal data and information, in either a hard copy or electronic form, for a maximum of six years at which point it will be destroyed. I confirm that I give my consent to the Equity Charitable Trust to process this information for the purposes of: My application being considered by the Welfare Committee The Equity Charitable Trust sending my application to other charities that may be able to assist me The Welfare Committee providing me with support Signed ………………………………………. Date ……………………………….. Please note we’re unable to process your application without your signed consent. Be sure to scan the signature page when returning the application by email, or post it to the Equity Charitable Trust, Plouviez House, 19-20 Hatton Place, London EC1N 8RU We can’t proceed without record of your signature.
Professional Name:	Legal Name (if different)
Spotlight Pin number:	Equity Number:
What year did you join Equity?	What job enabled you to join?
Address:
How did you hear about us?
Home Number:	Can messages be left at home? Yes / No
Mobile Tel No:
Email Address:	Date of Birth:
Married Partnered Separated Divorced Widow/er Single
If you have a partner, what do they do for a living? How much does your partner earn per month? How much did your partner net in the last 12 months?
If you have children please tell us their DOB
Do you have any other dependents?
How much did you earn during the last 12 months? Are you working at the moment and if so how much do take home per month?
Do you receive any royalties?
Please tell us about other income such as pensions, rentals, lodgers, maintenance or your partner’s earnings: If yes, is this weekly or monthly? Please state
STATE BENEFITS	YOU (per week/month)	PARTNER per week/month)
Retirement Pension: Pension Credit:
Child Benefit:
Income Support:
Job Seekers Allowance:
Universal Credit:
Child Tax Credit:
Working Tax Credit:
Incapacity Benefit:
Employment & Support Allowance (ESA):
Disability Living Allowance OR PIP Daily Living Component: Mobility Component
Attendance Allowance:
Carer’s Allowance:
Any Other Benefit Income:
Have you applied to any other charities? If yes, which ones? Have you received past help from us or any other charities?

PLEASE INDICATE IF THE FIGURES ARE WEEKLY OR MONTHLY
How much is your monthly rent? Please tick as appropriate: Council, Housing Association or a private tenancy
How much HOUSING BENEFIT OR UNIVERSAL CREDIT helps cover the rent?
How much is the Service Charge?
How much are your Mortgage repayments? Is it endowment, interest only or repayment?
How much does INCOME SUPPORT, UNIVERSAL CREDIT or ESA covers the Mortgage?
How much was the Mortgage taken out for?
Is there a second Mortgage on the property? And if so, for how much?
How long does the Mortgage have left to run?
Current property valuation (check on zoopla or mouseprice)
How much is your monthly Council Tax?
How much of that is covered by council tax relief from the local authority?
Household Contents and Buildings insurance:
Private Health and/or Life Insurance:
Heating & lighting costs:
Water Rates:
Mobile, internet & land lines:
TV License and cable costs:
Care assistants or cleaners:
Weekly spend on food:
Car Tax, Insurance and repairs :
Travel costs:
Prescription charges, treatments, osteopaths, physiotherapy, dentistry, etc.
Spotlight:
Equity Subscription:
Accountancy:
Debt Repayment Charges:
Any other outgoings:

ASSETS AND DEBTS	YOU	PARTNER
Funds held in bank account:
How much is your overdraft facility?
Funds held in savings account:
Total of investments + ISA’s
How much do you have outstanding, in total on all your credit cards?
How much do you own on loans?
How much is outstanding on your student loan?
Have you ever been bankrupt?
Do you have any County Court judgements
Do you have any rent or utility arrears? If so, how much
Do you owe any tax to HMRC?
Have either of you made any arrangements – either privately or through a 3rd party such as a CAB – on how to deal with your debts, if you have any? If not, would you be interested in seeking advice from us?

PAYMENT DETAILS

If your grant is successful, it is our policy to make payments direct to the appropriate service provider in order to expedite matters. Please note that we don’t pay for credit cards or loans.

The name of your Service Provider ……………………………………………………….(i.e. landlord, utility provider)

Your account name: ……………………………………………………………………………….

Your account reference number:…………………………………….………………………

In some circumstances, payment is made directly to the applicant. We usually pay by bank transfer so please complete the details below in the event that your application is successful

By completing this form, you are giving us permission to keep your details on file temporarily

Your banking name…………………………………………………………………………..Bank………………………………………..

.

Sort code: …………………Account number………………………Building Society/Roll No………………………………….

Signature: ……………………………………………………Date: ………………………………………………………………………….….

5) PLEASE TELL US IN YOUR OWN WORDS WHY YOU’RE APPLYING FOR A GRANT:

I enclose my CV I GIVE MY EXPLICIT CONSENT THAT THESE DETAILS MAY BE SHOWN TO OTHER CHARITIES & ORGANISATIONS WHO I BELIEVE MAY CONTRIBUTE TO THE PROCESSING OF MY APPLICATION, OR WHO COULD GIVE FURTHER ASSISTANCE TO ME. I also understand that the ECT is legally obliged to keep my details on file for 6 years Signed ………………………………………. Date ……………………………….. The Equity Charitable Trust will respect client confidentiality at all times. This is signed in accordance with the General Data Protection Regulation 2018

Other charities that might be able to assist you:

Here are a list of other theatrical charities which if, given your consent, we could approach on your behalf provided you fit their criteria. Please note that it’s unnecessary to apply to more than one of these charities at a time once you’ve granted us permission to share your information.

Remember to tick the right hand box if you’ve approached them already

Tick if already contacted
ACT	Helps children of actors up to the age of 21
ACTORS’ BENEVOLENT FUND (ABF)	Grants for actors and stage managers who are unable to work due to illness, an accident or old age.
CINEMA & TELEVISION BENEVOLENT FUND	Welfare grants for cinema and TV employees with at least two year’ experience (excl BBC). Doesn’t support actors, performers or students. Also runs a care home for elderly members of the technical professions.
DANCE PROFESSIONALS FUND	Offers confidential advice and financial support for professional dancers, ex-dancers, choreographer and dance teachers.
Dancers Career Development (DCD)	DCD offers dancers independent, confidential advice and career development guidance as well as financial support for retraining
Drury Lane Theatrical Fund	Offers grants to performers and back stage staff over the age of 40 who have worked at the Drury Lane Theatre
Evelyn Norris Trust	Funds breaks for professionals who are convalescing from an illness or those who can’t afford a holiday. No long term care is provided for.
Equity Benevolent Fund	Helps Equity members in financial need with modest one-off grants and welfare advice. Student fees and convalescent care are not provided for.
The Grand Order of Water Rats Charity	Offers assistance to professional and ex-professional entertainers and their dependents
Help Musicians	Helps professional musicians of all genres, from starting out through to retirement, in times of crisis or by providing opportunities to aid ones career
The Ralph & Meriel Richardson Foundation	Provides grants to professional actors and their families who are experiencing hardship
Royal National Theatre Fund	Advice and grants, apart from students, for anybody who works or has worked at the National Theatre.
Royal Opera House Benevolent Fund	Grants for current and past employees, including their families, of the Royal Opera House or the Birmingham Royal Ballet
Royal Theatrical Fund	Grants for professional practitioners who have contributed to the theatrical arts for at least 7 years who can’t work due to illness, infirmity or adversity. This includes family and dependents, but excludes students and school fees.
The Royal Variety Charity	Offers financial assistance for members of the entertainment industry. They also run a residential home at Brinsworth House, Twickenham
The Theatrical Guild	Offers backstage and front of house personnel access to counselling, welfare advice, financial aid and educational grants for non-performance related retraining