APPLICATION FOR FINANCIAL ASSISTANCE  

In order to comply with the terms of The Tracy Trust Charity, would you please complete the following:
 
I am applying for financial assistance for: (state item, service or treatment)
 
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I confirm that I have no reasonable alternative means of paying for this.
 
 
Signed: ………………………………………………………………….…
 
Date: ………………………………………………………………………
 
 Please print full name and address below:
 
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SL …………………..
 
Telephone: …………………………………………………………………
 
Email: …………………………………………………………………...…..
 

                             Please ensure that you enclose all relevant documents / invoices.
 
                             All applications will be subject to approval by The Tracy Trust Trustees.
                             Applications should not be made retrospectively.


                                             The completed form is to be returned to the Treasurer:-
                                               Rainer Struck, 9, Hedgerley Hill, Hedgerley, SL2 3RJ
                                                                               Tel: 01753 646883