Temporary accommodation costs Insurance excess payments

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1 Norfolk & Lowestoft Flood Recovery Fund Emergency Grants for Individuals and Families Grants may be made for charitable purposes to relieve hardship in Norfolk and Waveney caused directly or indirectly by the storm and flooding in December Funded by donations from individuals, and local authorities, businesses, trusts, charities and agencies. Who can apply? Individuals or families whose sole and main residence has structural damage or flooding as a direct result of the recent storms Employees who have lost work or income because of storm or flood We can particularly provide support with the following: Cleaning up and repairs Emergency repairs Clothing Food and drink Heating/ heating equipment, including additional heating costs and e.g. dehumidifiers Cookers and kettles Child care equipment eg. sterilizing equipment Specialist medical equipment Beds and bedding Basic furniture This is not an exhaustive list. Temporary accommodation costs Insurance excess payments Priority will be given to households with: People over 70 Children under 5 People with physical or learning disabilities or mental health needs People in receipt of job seekers allowance, low income or disability benefits Low incomes We will not normally fund: Losses which are covered by insurance Vehicles How much can you apply for? Grant are normally in the range of , though in some circumstances grants of up to 2,000 can be considered.

2 How to apply: Complete the application form for Emergency Grants for Individuals and Families, and return to: Lisa Grice Housing Team Leader Customer Services, Housing Services, Holt Road, Cromer, Norfolk, NR27 9EN For advice and assistance with making an application contact: Housing Options Team Emergency grants are also available for Voluntary and Community Groups.

3 Emergency Grants for Individuals and Families - Application Form Please read the advisory notes before beginning an application, and complete the form as fully as you can. Name of applicant Mr / Ms / Mrs / Miss/ Other Address for correspondence Postcode Usual address (if currently in temporary lodgings) Contact telephone numbers: Daytime Evening Mobile address Number of people in your household Of those, number aged over 70 Number aged under 5 Number receiving Disability Living Allowance, Incapacity benefit or Attendance Allowance Type of house please delete as appropriate Detached Semi-detached

4 Terraced Bungalow Flat Other: Is this property your sole and main residence? YES / NO Are you : please delete as appropriate An owner A tenant - Landlord s name: Describe the impact of the flood/ storm: eg. loss of electricity, house flooded etc. Please note the site may be visited and photographed to verify the damage stated here.

5 If awarded, what would the funding help with? Brief details Estimated cost Cleaning up Emergency repairs Clothing Food and drink Household goods Accommodation costs Other

6 Amount requested from this Fund Do you have the means to cover the costs included in this application, in full or in part? Which of these benefits does anyone in your household receive? We may ask to see proof Income support Income based job seekers allowance Pension credit Housing benefit Council tax benefit Other : Are you fully insured? YES / NO If YES, who is the insurer? Type of insurance (e.g. buildings, contents): If NO please explain why Have you applied for any other funding or help? If so, please provide details below: Funder Type of support/ amount of funding Applied for/ received

7 Payment details If you are successful we will make the grant payment by cheque, or directly into your account by BACS. below. Please enter the details of your bank/ building society account Name of group s bank account Name of bank/building society Sort Code Account Number If payment will be made by cheque please confirm the payee name that the cheque should be made out to:

8 Declaration I am authorised to make this application. I certify that the information provided in this application is correct. I give permission for the organisations involved in providing this funding to record the information in this form electronically. I understand that I may be asked to participate in publicity and evaluation activities related to these funds The fund holder reserves the right to reclaim any money which has been paid as a result of fraudulent or misleading claims. Person completing the application form: Signature (Please sign) Name (Please print) Date: OFFICE USE ONLY To be completed by Council officer sign to confirm approval for payment Application approved? YES / NO Amount Signature (Please sign) Role

9 Name (Please print) Date:

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