Hardship Fund Application Form

Latest revision date: April 2023
Revision due date: April 2024

Who is this form for?

This form is for Berneslai Homes tenants only and those named on the tenancy itself.

Our hardship fund is to support our tenants who are experiencing financial hardship, if eligible we can look to offer support with:
  • Food (supermarket vouchers)
  • Utilities(energy vouchers)

Please note we may only be able to award one of the above due to funding.

The grant does not have to be repaid. It is intended to help if you don't have enough money to meet your short-term needs. The Hardship Fund cannot be awarded indefinity and you do need to look to have shown that you have bettered your financial situation or tried to if you are applying for this Fund again.

The grant does not have to be repaid. They're intended to help if you don't have enough money to meet your short-term needs.

You will need to provide proof of all income/benefits received and bank statements for the last 3 months for the whole household in order for us to consider your application. If applying for energy vouchers, please provide proof of energy bill or meter showing the debt. These can be uploaded to this application at the end before submitting. Please complete all sections of the form, if no proof is attached, your application will not be considered.

How we assess your application

Based on the information and evidence you provide on this form we will assess your affordability for the eligibility of the Hardship Fund. We look at each application on a case-by-case basis.

Protecting your personal data

By completing this form, you acknowledge that we will follow our responsibilities under the data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information, please see our privacy policy on our website

You may be contacted further by a member of our team, where you agree to receive further support for the Achieve programme (if eligible), please see our website

Please note we use Charis Grants who are the trusted administrator for these funds. Their Privacy policy can be found on Charis Grants Website
  • Opening Questions

  • Are you a Berneslai Homes Tenant and Named on the Tenancy Agreement?

  • Unfortunately, you do not meet the criteria for the Hardship Fund we hope you can get further support by contacting Citizens Advice on 0800 144 8848.

  • Are you in rent arrears?

  • How much are the rent arrears?

  • Unfortunately, you do not meet the criteria for the Hardship Fund we hope you can get further support by contacting Citizens Advice on 0800 144 8848.

  • Are you in debt with any of the following priority bills? Rent/Council Tax/Energy/Water

  • You will need to provide proof of the debts as stated above. Please use the upload section below to upload this evidence. If proof is not provided your application will not be considered

  • Have you received any support from any debt agencies such as Citizens Advice/Step Change within the last 3 months?

  • Have you received any support from any debt agencies such as Citizens Advice/Step Change within the last 3 months?

  • Which Agency are you in debt with currently?

  • Are you in financial hardship? (No source of income through employment or benefits or a sudden reduction of income)

  • Are you state pension age?

  • Are you state pension age?

  • Have you received support from the hardship grant in the last 3 months?

  • Unfortunately, you do not meet the criteria for the Hardship Fund we hope you can get further support by contacting Citizens Advice on 0800 144 8848.
  • Criteria

  • You complete the Income and Expenditure part of this form below showing income through employment or income through benefits and showing debt/ rent arrears.

  • Supporting documentation (i.e., bank statements/ bills)

  • The household is in rent arrears and must have a payment plan in place with the Income team (this must be recorded on our system)

  • The household does not meet the criteria for other support grants available

  • Do you have additional support needs (mental health, physical health, improve family relationships, social isolation or exclusion from wider family networks). If vulnerability is identified on this form, we will follow our vulnerability protocol.

  • Please provide more information on this:

  • Are you experiencing any Damp or Mould within the property?

  • Please provide information on where the damp or mould is in the proerty. Please note we will pass this to the damp and mould team to look into.

  • Do you give consent for Berneslai Homes to share your customer case study with our funders, as well as where applicable to meet with commissioners to share your story and give consent for photographs to be used in the director of Public Health Repor

  • Please note Berneslai Homes will verify that there is no other source of financial support available, or it is impractical to access alternative financial support and we will make a note of this on your rent account. We will also check the rent account to see if any previous awards have been made.

    We may also refer your details into the Tenants First Achieve Team for support with work, skills & qualifications (if eligible).

  • Personal Detalis

  • Title

  • First Name

  • Last Name

  • Address

  • Rent Reference Number

  • Phone Number

  • Please ensure you enter your mobile number correctly, if your application is granted, we will send the voucher(s) to the number you provide on this application. If you do not have a smart phone, please enter a valid email address for the vouchers to be issued if your application is granted. Please note we cannot reissue the vouchers once sent to the mobile number.

  • Email Address

  • Please ensure you enter your email address correctly, if your application is granted, we will send the voucher(s) to the email address you provide on this application. Please note we cannot reissue the vouchers once sent.

  • Prefered Method

  • Who Lives with you?

  • How many people live with you?

  • Regular Income

  • How many regular incomes do you have?

    (Please use the Add button to create a new Income Source each time)

  • Regular Outgoings

  • How many regular Outgoings do you have?

    (Please use the Add button to select a new Outgoing each time)

  • Help you need

  • What are you wanting to apply for?

  • Where do you shop?

  • Who is your Energy Supplier?

  • How do you pay for your energy?

  • Your Circumstances

  • Please tell us any recent changes/ circumstances and any financial difficulties you are currently experiencing along with any other support you may require?

  • Would you like to be referred to our Tenant Support Service team for personal budgeting support and if needing any other financial support?

    For more information on the Tenant Support Service please see our website

  • Please explain what other support you require below

  • Please explain why you would not like to be referred *

  • Upload Documents
  • Use this section to upload any information that may help us deal with your application. You will need to provide proof of all income/ benefits received and bank statements for the last 3 months for the whole household in order for us to consider your application. If applying for energy vouchers, please provide proof of energy bill or the meter if on pre-payment showing the debt. To upload this information, you can either use a scanner or take a photo with your phone or tablet. Just click the upload button. More than one piece of information? Just click the “Add” button after you’ve finished uploading each one. You can upload a maximum of five pieces of evidence. If you haven’t got the evidence to upload at this point you can save your form until you have.

  • Documents of Proof

    You can upload the following file types: JPG, PDF, PNG
    Please note if you are going to save this form instead of submitting, you will need to upload your file when you submit.

  • Checklist/ Privacy Policy

  • Please read the below statements and confirm, do you agree:

  • Agree that you have met the eligibility criteria as set out above *

  • Individuals caught falsifying or making duplicate claims for the hardship fund/ or selling on vouchers/ other false claims/ deception/ support will be required to return the funds/ items. By agreeing to completing this form you meet the eligibility for this Hardship Fund and support.

    I understand that only one claim can be made per household, and confirm I have not applied for, received support in respect of this from any other department in the council or from another organisation.

  • I agree that the vouchers are for my personal use only. *

  • You give permission to allow Berneslai Homes to contact other organisations/ professional bodies to support the assesment of this Hardship Grant and provide you and your family with ongoing support to meet your needs. *

  • Agree that if you do not agree with the form that we may not be able to support you and your family with your request. *

  • I can confirm that the information on this form is true and that we may contact you if we need to discuss this further. *

  • Agree to the data matching/ sharing statement below: *

    Berneslai Homes is under a duty to protect the public funds it administers and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information under arrangements with a specified anti – fraud organisation under section 68 of the Serious Crime Act 2007. For further information see Data Sharing for the Prevention and Detection of Fraud

  • Agree and understand that my personal details, name, address, email address and phone number will be shared with Charis/ HACT for the sole use of being provided with a payment card to put fund on utilities. *

  • Confirmation
  • By completing this form, you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information, please see our privacy policy on our website