All fields are required.

Are you filling in this form for yourself?
—Please choose an option—YesNo

Personal details

Name of applicant

Applicant address

Applicant phone number

Applicant email

Applicant DOB

Household information

Are you
—Please choose an option—SingleCoupleFamily

Age and relation of family members you live with

Number of people in household who will benefit from this grant

Application Questions

Please describe your current situation/hardship you are facing

How will a grant of up to £250 help you/be used?

What other agencies are helping or supporting you?

Income details

Monthly income (£)

Monthly expenses /outgoings (£)

Are you entitled to/receiving benefits?
—Please choose an option—YesNo

Other Support needed

What other help do you need/ feel would be useful in addition to the hardship grant ? (This allows us to signpost you to other services internally and externally)

Supporting Documents

Please upload the following:
Recent bank statements for past 3 months

ID Document (Passport or Driving Licence)

Any other supporting documents

I consent to As Suffa processing and storing my information for the purpose of the hardship grant. I understand a full copy of As Suffa privacy/data protection policy is available on request.
I confirm I am Muslim and eligible for zakat.