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Grant Aid Funding Enquiry

Please note that this is not a grant application

If the work is needed to adapt the property for someone who is disabled, please contact the North Lincolnshire Council Occupational Therapy Hotline on 01724 298206 or contact Environmental Health - Housing on 01724 297638 for more information on Disabled Facilities Grants.

Full name of applicant(s)

Title
If Other, please specify
First name(s) *
Surname *
Date of birth *	Date of birth Month Day Year

Please use the Add button to enter the full name for each applicant, if more than one.

Address of property grant aid applied for:

Please enter your post code in the box below and then click on the "Lookup address" button. If your address is NOT SHOWN in the list or is incorrect, you will need to type your address in the boxes provided. In this case please supply as much information as possible.

Post code Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.


Prefix e.g. first floor flat.
House name/number
Street
Town/Village
County

Is the above address the same as your home address? *

Is the above address the same as your home address?

Yes

Your address (if different from above)

Please enter your post code in the box below and then click on the "Lookup address" button. If your address is NOT SHOWN in the list or is incorrect, you will need to type your address in the boxes provided. In this case please supply as much information as possible.

Post code Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.


Prefix e.g. first floor flat.
House name/number
Street
Town/Village
County

Your telephone number(s)

Home telephone:

Work telephone:

Contact email address

(Note: on submitting your completed form, if you have provided a valid email address above you will automatically receive a copy of your completed form).

For the property to be improved are you, or will you be: *

If you are living at the property, what date did you move in?

Please indicate if any of the following are missing from the property

Inside toilet	Hot and cold water to basin
Bath in a bathroom	Kitchen sink
Hot and cold water to bath	Hot and cold water to kitchen sink
Wask hand basin	Heating

Are there any children living in the property?

Yes

If Yes, please give their date(s) of birth

1st child

2nd Child

3rd Child

4th Child

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