I declare that I have understood all the questions that Liversage Trust has asked and that that the information contained in the form is correct. I also understand that the Liversage Trust is legally required to verify the personal circumstances of applicants for charitable grants. I declare that we are not related by family and that we do not have a personal relationship.
I declare that if this application is successful, only the items as stated in this form and approved by the Trust will be obtained and I undertake to provide the Trust with receipts for all items purchased. I further understand that the Trust reserves the right to verify that the grant has been applied in the way intended, if necessary, by making an appointment to visit the applicant’s home.
I understand that any deliberately false statement or omission of material facts may result in action being taken against me.
For the purposes of the Data Protection Act 1998, I consent to the information contained in this form, and any information received by or on behalf of Liversage Trust relating to this grant application, being stored on the Trust’s computer with a paper copy of the summary in a manual file, for the sole purpose of grant processing, analysis and accounting. The Trust will treat all information in the strictest confidence and will not divulge it without the prior agreement of all concerned.
I also give permission for my details to be shared with other third parties, where necessary, for the purpose of determining a Grant award through the Liversage Trust.