Apply for Cost of Living Assistance Funding

Cost of Living Assistance Fund Application

Please complete this form to make an application for financial support from the Cost of Living Assistance Fund.
About your data
We will ask you for information in order to handle your application and we will use it to contact you. Our privacy policy explains how we handle your personal data.
Household details
Title
First name
Last name
Date of birth
Best daytime contact number
Email
Confirm email
Address line 1
Address line 2
Town or city
Postcode
Your National Insurance number
Your Partner’s name
Number of adults resident (18 and over)
Number of children resident
If the person completing the application is not the applicant named above, please confirm your name and contact details and tell us your relationship with the applicant and why you are completing the form on their behalf

Reason for application
Please use the box below to explain why you are seeking financial support from the Cost of Living Assistance Fund. Please be sure to include details of any current arrears with utility/energy bills.
Reason for application

Evidence requirement:
Once you have submitted your application you will be contacted to provide the evidence required to consider your application.
This will include a recent bank statement for the account(s) normally used by you to pay your bills, proof of your identification and your most recent wage slip(s).
By submitting this application you confirm that you are experiencing financial difficulty and that the information given is an honest and true reflection of your current financial position.
If you are in receipt of housing benefit, with your permission, we can check your housing benefit records to confirm the amount that you receive. Please tick box to give your permission
To help us avoid abuse of our system, please enter the correct answer to the question below

What colour is snow?

Household details