Application for Financial Assistance

Who is eligible to apply for financial assistance?

Past and present members of the IMarEST and past and present members of the Guild of Benevolence
Marine engineers who possess or have possessed STCW Convention equivalent Management (M) or Operational (O) level Certificates of Competency issued by an IMO White List-recognised national maritime authority
Any individual professionally engaged, now or in the past, in the marine sector as an engineer, scientist or technologist at a level eligible for IMarEST membership as a Fellow, Member or Associate
The wives, husbands, widows, widowers, partners, children and/or dependants of any of the persons referred to above

Before you begin

Please allow about 15-20 minutes to complete this form.

If you have any difficulties with any of the questions shown on the form, please call the Guild of Benevolence on 020 7382 2644 or contact [email protected].

If you already recieve assistance and need to complete an assessment for continued financial support, please complete this form.

Applicant details

First Name

Surname

Date of Birth

Address Line 1

Address Line 2

City

Postcode

Job Title/Position

Marital Status

Contact Number

Email Address

Applicant's next of kin

Name

Address Line 1

Address Line 2

City

Contact Number

Dependants of applicant

Number of Children

Age(s) of Child(ren)

Full Time Education

One or more of my children are in full time education

Details of person on whom eligibility is based

First Name

Surname

Relationship to Applicant

Date of Birth

Date of Death (if applicable)

Cause of Death (if applicable)

Rank at End of Service

Reason for Discharge

Date of Discharge

Discharge Book Number

Service

Service From

Service To

Other relevant information

Name of Caseworker (if applicable)

Caseworker Contact Number (if applicable)

Reason for Unemployment (if applicable)

Last Employer

Last Job Title

Date Left Last Employment

Please state your previous positions held, with dates. If sea-going, please provide names of ships, owners and rank held.

Please provide any verification of your sea service (if applicable).

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Has an application for financial assistance been made by you, or on your behalf, to any other Charity, organisation or society?

Yes

If yes to the above, please provide details, including which organisation, and result (if known):

Income

Please provide the WEEKLY income for each and any of the following sources, including any from a spouse or partner.

Only enter numbers in numeric form, e.g. '50.00' or '150.75'.

Earnings from Employment

State Retirement or Widows' Pension

Bereavement Allowance

Pension from any other source

War Pension/Service Pension/Service Disablement Allowance

Armed Forces Compensation Scheme

Income Support Jobseekers Allowance

Universal Credit

Employment and Support Allowance

Working Tax Credit

DLA or PIP

Attendance Allowance

Carer’s Allowance

Stautory Sick Pay

Incapacity Benefit

Severe Disablement Allowance

Industrial Injuries Disablement Benefit

Child Tax Credit

Child Benefit

Widowed Parent’s Allowance

Guardian's Allowance

Housing Benefit

Council Tax Benefit

Care Home Funding

Property Income

Interest/Dividends/Other Annual Payments

Family Contribution

Charity/Organisation Grants

Other Benefits

Debt/liabilities

For each and any of the below, please enter the purchase dates, frequency, and total amount of debt incurred.

Loan

Credit Card

Your expenditure

Detail both the weekly expenditure and any costs in arrears.

For example, if you spend £700 a month on your mortgage but have £400 in arrears, write it as '£175 (weekly), £400 (arrears)'.

Rent

Council Tax

Water and Sewerage

Heating and Lighting

Insurance Premiums

Hire Purchase Payments

Care Home Expenses

TV License and/or Rental

Telephone

Housekeeping

Clothing and Shoes

Travel

Medical Expenses

Reading Materials

Other Expenses

Savings and capital

Only enter numbers in numeric form, e.g. '50.00' or '150.75'.

Cash in Hand

Cash on Deposit

Other Investments

Personal summary

Please tell us in your own words why you are seeking financial assistance. The information provided here will significantly help your application during the consideration process.

Declaration

To be completed by the applicant

I declare that the information I have given is correct

I agree that the details on this form may be passed in confidence to other agencies and charities

I accept that if a regular grant is awarded it will be subject to an annual review

Application for Financial Assistance

Who is eligible to apply for financial assistance?

Before you begin

Offices

Europe

Asia-Pacific