Online Application Form

Download the form using the button opposite. The form can be completed by hand or by typing into the pdf form. If typing you must still print, sign and send the form as per the following guidance notes.

Guidance notes for completion of application forms

  1. Please complete EVERY section of the form clearly with as many details as possible.
  2. All information given will be treated in the strictest confidence.
  3. If full financial details are NOT completed the application form will be returned.
  4. The form must be endorsed with a supporting statement by a professional working with the individual/family.
  5. On returning the application form please enclose SPECIFIC QUOTES for the items requested. It is suggested that quotes be obtained from Cooper and Elms and Economy Cookers for electrical items, as we have found them to be reasonable and reliable suppliers. We have also found that the Derwent Range is a decent quality carpet at a reasonable price and that range or similar priced range will be considered.
    Please obtain a quote per square metre for carpets.
    This will enable the charity to assist as many applicants as possible.
  6. On completion the form should be returned to:-
    The Secretary, Bank House, Middle Drove, Marshland St James, Norfolk, PE14 8JT. Marked “PRIVATE & CONFIDENTIAL”.
  7. The Secretary can be contacted on 01945..430599 or at with any queries.
Download Application Form


King’s Lynn & West Norfolk Borough Charity Coverage

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