Apply for Hardship

UFCS Comprehensive Hardship Assistance Application Form

To better understand your household’s needs and provide tailored assistance, please complete the following detailed information. Accuracy is crucial for successful application processing. Your privacy and confidentiality are paramount to us.

A fill out application form

Primary Applicant

Full Name

Date Of Birth

Gender

Email Address

Phone Number

Address

City

Employment Details

Occupation

Employer's Name

Employer's Phone number

Monthly Income

Employment Status: Full-time/Part-time/Unemployed

Household Members Information Member 1 (Primary Applicant)

Full name

Relationship

Date of Birth

Employment Status

Occupation

Employer's Name

Employer's Phone number

Member 2

Full name

Relationship to Primary Applicant

Date of Birth

Employment Status

Occupation

Employer's Name

Employer's Phone number

Children Information (Child 1)

Name

Date of Birth

Is your child attending school, unemployed or employed. Give details

Child 2

Name

Date of Birth

Is your child attending school, unemployed or employed. Give details

Child 3

Name

Date of Birth

Is your child attending school, unemployed or employed. Give details

Current Household Situation

Number of Bedrooms in Home

Monthly Rent OR own house

Monthly EFL Bill and water bill approx

Monthly Expenses Breakdown

Groceries

Transportation (Own car or public transport user)

Healthcare

Education

Declaration

hereby declare that all information provided in this application is true and accurate to the best of my knowledge. I understand that UFCS may verify the details submitted, and any inaccuracies may lead to the rejection of my application. I also acknowledge that UFCS reserves the right to decline my application without providing reasons, due to the high number of applications and individuals they support.

If your application is accepted we will visit your premises or call you to visit us for further information . Application accepted is based on the situation of every household and the limit we have in acceptance.