To apply for a grant you can either display and print the pdf file John_Holford_Application_Form.pdf or complete all the boxes below and press [Send]. Before filling in this on-line form please prepare any supporting documents in Word .doc format and attach them to your submission where prompted. Please be aware that incomplete applications may be rejected by the Trustees.




The Relief of Persons who are in conditions of need, hardship or distress.

Applicants must be resident in either:

[A] The parish of Clutton

[B] The parish of Middlewich

[C] The Borough of Congleton

[D] The Ecclesiastical parish of Astbury

1. Surname 2. Christian names 3. Address 4. 5. 6. Date of birth (ddmmyy) 7. List all dependant children and give details of age and whether they are living with You (name, age, yes or no) 8. Do you have any other relatives dependant on you? 9a. If YES, state relationship and reason for dependence 9b. State weekly amount contributed by you 10. Does any such dependant receive Income from any other source? 11. If YES, give details and amount 12a. Are you working? 12b. Is your spouse working? If Yes to 12a state: 13ia. Your occupation 13ib. Name and address of employer 13ic. Gross annual wage *1 If Yes to 12b state: 13iia. Spouse’s occupation 13iib. Name and address of Spouse’s employer 13iic. Gross annual wage *1 14. Are you retired? If Yes to 14 state: 14a. Amount of National Pension received for yourself 14b. Amount of National Pension received for your spouse 14c. Amount of all National Supplementary Pension received 14d. Amount of any other  private pensions receive  by you and your spouse 15a. If you are not working state reasons 15b. Are you receiving any State assistance? *2 16. If YES  give amount 17a. If you do not own your own home, state weekly rent paid 17b. Amount paid in rates 18a. Do you have Capital? *3 18ai. What is the value of your Capital? *3 18aii. What is the value of your spouse’s Capital? *3 State below the value of any dwelling you and your spouse own, after deducting the outstanding mortgage 18bi. The property you live in 18bii. Any other property 18biii. Annual mortgage repayment 19. Other income, give Details *4 20. How long have you lived in any of the places specified at the beginning of the form? 21. State for what reason you apply for financial relief and give all relevant information which will assist the Trustees when considering your Application *5
Yes No No Yes No Yes No Yes No Yes No Yes No Yes
Remember to attach your certificate of your earnings, your spouse’s certificate of earnings, supporting Letters and other supporting Documents to your email Before you finally SEND. Please ensure all relevant questions have been answered before clicking [Continue]


You will need to attach to this form a certificate of earnings signed by your employer, or if Self Employed, by your Accountant


Sickness benefit, unemployment benefit, redundancy pay, etc.


Capital is cash, savings or investments, other than your house


From rents, dividends interest, annuities, Building Society & bank deposits etc


You can attach a separate Word.doc document below