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Serving Humanity since 2008
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About Us
Projects
Food Packs
Winter Blanket Project
Masjid Solar Energy Kit
Water Hand Pumps
Recovering Eyesight
Replenishing Lives With Water
Constructing Buildings of Hope
Education
Sponsoring Care
Local Advisory & Visa Guidance
Training Skills for Life
Hygiene Relief for Rohingya Refugees
Education Kits
Cyclone Yaas Shelter Project
Gallery
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Contact Us
Application form for Individuals
Person Details
Name
*
Date of Birth
*
Email
*
Address
*
Telephone
Mobile
*
Please tick the appropriate box that applies to you.
*
Single
Married
Divorced
Widowed
Qualifications obtained from schools, colleges and universities.
Please list highest qualifications first:
*
Bank Details (Account Numbers, Bank Branch details)
Bank Name
*
Branch
*
Account Holder Name
*
Sort Code
*
Account Number
*
IFSC
ID Cards (List of all ID cards held with ID Numbers)
Aadhar Card
Ayushman Bharat Card
Mukyamatri Amrutam Card
Palak Mata Pita
Employment Detail
Job Role
*
Monthly Salary
*
Address of Employment
*
Work Contact Number
*
Joint Family Details (If applicable)
Name
Age
Relationship
Working
Salary Per Month
Family/Friends Abroad
Name
Contact Number
Mobile Number
E-mail Address
Address
Details of Requirements
Please use this section to explain in full detail the help that you require. Please include your welfare, training, medical & any other needs you may have.
Have you applied to any other organisations for help? Please tick.
Yes
No
The organisation you have applied to
What sort of help you requested
What help they offered to give?
References (Please provide two referees)
Referee Name 1
Relationship
Position
Organisation
Telephone Number
Mobile Number
Address
Email
Referee Name 2
Relationship
Position
Organisation
Telephone Number
Mobile Number
Address
Email
Declaration
I acknowledge that Peoples Needs CT is under a duty to protect the public funds it administers and to this end I agree it may use information provided on this form for prevention and detection of crime and it may share this information with other bodies solely for these purposes. I hereby give consent to such collection, storage and processing of my personal data and I agree that the information given on this form may be used for data registration purposes. I hereby certify that:
All the information given by me on this form is correct to the best of my knowledge.
All questions relating to me have been accurately and fully answered.
I possess all the qualifications which I claim to hold.
If given funds, I will use them appropriately and within the legal framework of the country.
Peoples Needs CT retains their right to withdraw existing and future support at any time and without notice.
Peoples Needs CT will not be held responsible for actions undertaken by recipients who are deemed to be
unlawful.
Signed Date
*
Signed Full Name
*
