Application Test Page October 24 (CL)

Your application for financial help

If you can't complete the whole form right now, don't worry - you can save your progress and return later. Just use the link at the bottom of the page.

Step 1 of 13

Section 1: Your details
Your name*
Title First name Middle name(s) Last name
Email address*
Please ensure you enter a working email address so we can contact you.
Postal address*
Address line 1 Address line 2 Town/City County Postcode Country
Home phone number
Mobile phone number*
Date of birth*
dd/mm/yyyy
Marital status*
If more than one option applies, please choose the one that best describes your current situation
- Married
- Living with Partner
- Co-habiting
- Single
- Separated
- Divorced
- Widowed
Partner/spouse's name (if applicable)*
Title First name Middle name(s) Last name
Partner/spouse's date of birth (if applicable)*
dd/mm/yyyy
Partner/spouse's occupation (if applicable)*
How did you hear about the RMBF?*
Please provide details of any communication requirements you have due to medical reasons, e.g. large print letters

Save and Continue Later

Type of vehicle	Make and model	Year	Current monthly repayment (if applicable) (£)

Royal Medical Benevolent Fund

Application Test Page October 24 (CL)

Your application for financial help

Step 1 of 13

Section 1: Your details

Section 2: Your details (cont.)

Section 3: Other people who live with you

Section 4: Household income

Your income from employment

Your partner/spouse's income from employment

Your pensions

Your partner/spouse's pensions

Your state benefits

Section 5: Expenditure

Section 6: Bank accounts, savings and capital

Section 7: Debts

Section 8: Housing details

For home owners

Section 9: Cars and other vehicles

Section 10: Other charitable assistance

Section 11: Personal statement

Section 12: Agreements and declarations

Main agreement

Data protection agreement

Equality monitoring

Submit your application below

Name	Date of birth (dd/mm/yyyy)	Relationship to you

Description	Frequency	Amount (£)

Description	Frequency	Amount (£)

Description	Frequency	Amount (£)