PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS
 
STRICTLY CONFIDENTIAL
 
APPLICATION FOR SCHOOL CLOTHING ALLOWANCE
 
PLEASE READ             PAYMENT OF THIS AWARD IS BY ISSUE OF A CROSSED CHEQUE
CAREFULLY:                WHICH IS TO BE PRESENTED THROUGH AN ACCOUNT IN THE PAYEES NAME e.g. Bank, Building Society or Post Office.
                                    APPLICANTS MUST BE IN RECEIPT OF FREE SCHOOL MEALS
 

                                    IF YOU DO NOT HAVE THIS FACILITY PLEASE TICK THE BOX   
 
NAME OF CHILD FOR WHOM CLAIM IS BEING MADE ………………………………………….....................
 
NAME OF PARENT OR CARER
 
(a) Surname …………………………………………………. (b) Initials ………… (c) Mr & Mrs/Mr/Mrs/Ms ……...
 
HOME ADDRESS ………………………………………………………………….. Tel.No ………………………….
 
…………………………………………………………………………………………. POST CODE: ………………..
 
RELATIONSHIP TO PUPIL: …………………………………………………………………………………………….
 
NATIONAL INSURANCE NUMBER ……………………………………………………………………………………
 
TERMINATION DATE OF FREE SCHOOL MEAL AWARD …………………………………………………………
 
DATE OF THIS CLAIM                                                      …………………………………………...
 
DECLARATION OF PARENT OR CARER
 
I certify that the information given in this application is correct.
 
Signature of Applicant ………………………………………………………………….. Date: ……………………….
 
I acknowledge receipt of cheque for £…………………………….. and undertake to produce receipts for clothing
purchased within 6 weeks of the date below.
 
Signature of Applicant ………………………………………………………………….. Date: ……………………….
 
OFFICE USE ONLY
NAME OF CHILD ………………………………………………………………………………………………………….
 
TOTAL OF GRANT PAYABLE                                                               Date: ………………………………….