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 JOHN HOLFORD CHARITY
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
2. Christian names
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
Certificate of your earnings
Certificate of Spouse’s earnings
Supporting Letter 1
Supporting Letter 2
Other Supporting Document
22. The Trustees reserve the right to make such further enquiries as they think fit to enable them to give full consideration to your application and your completed application form will be construed as authorising the Trustees to make such further enquiries
Please ensure all relevant questions have been answered before clicking [Send]
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