Support and advice for businesses affected by COVID-19.

Emergency Assistance Grant form

Emergency Assistance Grant
1. The Local Authority Emergency Assistance Grant is to help support residents who do not have enough resources to meet the immediate short-term needs and urgently require assistance with food and essentials items. You must be experiencing financial hardship as a direct result of Covid-19.
  
  To be eligible for the scheme you MUST
  - live in Preston
  - be able to show us that you do not have the resources to provide food, gas or electricity and/or essential household items for yourself or your household as a result of the impact of either COVID-19 or other financial hardship
  Please ensure you have read our Emergency Assistance Grant Scheme information page.
  
  Please ensure you upload a recent full months bank statement, showing transactions, your balance and your name and address, otherwise your application will not be considered. We will accept screenshots of your bank statement.
2. Do you live in Preston?*
  
  Yes
  
  No
3. Are you completing this form for yourself or on behalf of somebody?*
  
  Completing the form for myself
  
  Completing the form for someone else
4. Your details
  1. Full Name
  2. Address line 1
  3. Address line 2
  4. Town/city
  5. Postcode
  6. Telephone number
  7. Email address
  8. Date of Birth
  9. National Insurance Number
  10. Are you (the Applicant) liable for Council Tax at the address given above?
    
    Yes
    
    No
    
    If Yes we will use your details to verify that you live in the City of Preston.
  11. Please provide your Council Tax reference number
5. About the person completing this form and the applicant
  1. Your full name completing this form
  2. The applicants full name
  3. The applicants Address line 1
  4. The applicants Address line 2
  5. Town/city
  6. The applicants Postcode
  7. The applicants Date of Birth
  8. The applicants National Insurance Number
  9. If the applicant gives you permission, please include there contact details as well as your own, just in case we need to contact you for further information.
  10. Your telephone number
  11. Your email address
  12. The applicants telephone number
  13. The applicants email address
  14. Is the applicant liable for Council Tax at the address given above?
    
    Yes
    
    No
    
    If Yes we will use your details to verify that you live in the City of Preston.
  15. Please provide your Council Tax reference number
  16. Relationship to applicant
  17. Agency you work for (if applicable)
6. Does anyone else live with you? *
  
  Yes
  
  No
7. Including yourself, how many adults live in the property?
8. How many children aged between 0 - 16 live in the property