PAF

Confirming your
Hospital Grant

Hospital Stay Grant

We have paid £150 directly into the bank account details you provided on the Hospital Stay Grant application form – this will normally clear within 24 hours, but in some rare cases can take up to 3 working days.

As per our terms and conditions, we now need you to complete the Payment Acceptance Form below. This must be done within the next 7 days.

Please be aware that failure to complete the PAF can result in the charity recovering their award of the grant.

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Payment Acceptance Form

Please complete all questions on this form

Payment Acceptance Form

Grant Reference Number (we sent this in your acceptance email)

Who are you?

Title

First Name

Surname

Mobile Phone

Address

Address Line 1

Address Line 2

City

County

Postcode

Grant Confirmation

I confirm that I have received the grant of £150 from Yorkshire Children's Trust which was paid into the bank details of the beneficiaries parent/guardians bank account using the details supplied on the application form.

I confirm the grant will be used for the intended purpose, which is to support the additional costs of having a child in hospital. The payment can be used for travel costs, car parking, food and drink in the hospital and items such as magazines, arts, crafts and activities for the child in hospital.

Confirmation

I can confirm the above grant confirmation statement

I understand my information that I have provided will be stored on a secure password protected system for a period of time as defined by law.

I understand that the charity reserve the right to see any receipts for the purchases using the grant award for a period of up to 12 months.

I understand this application was subject to the YCT Support Application terms and conditions and that I cannot make another application for a grant from the charity for 12 months.

Signature

Please use your finger or mouse to sign this document.

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PAF

Hospital Stay Grant

Payment Acceptance Form

Don’t forget to leave us a review

www.yctrust.uk/reviews

Registered Charity Number 1146884

Horley Green Works • Horley Green Road • Halifax • HX3 6AS

PAF

Hospital Stay Grant

Payment Acceptance Form

Don’t forget to leave us a review www.yctrust.uk/reviews

Don’t forget to leave us a review

www.yctrust.uk/reviews