Annual Review Annual Review Form Step 1 of 11 - If you are already receiving assistance from The Gurney Fund, please submit the annual review form electronically. 9% Please confirm that you are receiving/have received assistance from The Gurney Fund.* I am in receipt of / have received assistance from The Gurney Fund and I consent to the information I provide being held and processed by The Gurney Fund as necessary for the administration of this and any other application I make to the Fund. I consent to (a) the fact that I have applied and (b) details of any grant(s) made as a result of my application(s) being shared with a Subscribing Force and note the information may be shared with other Police Charities; to avoid duplication of grants. Save and Continue Later Applicant's Name*Your nameAddress* Street Address Address Line 2 City Post Code Email* Telephone No*Is this application the result of a death or retirement?*DeathRetirementForce at time of officer's death*Force at time of officer's retirement*Cause was*On DutyOff DutyDate of officer's death* Date of officer's retirement* Save and Continue Later Details of any grants. awards or compensation receivedBereavement AllowancePension CommutationDeath in Service BenefitPolice Federation AwardPolice Dependant's Trust AwardCompensation AwardedLife Assurance Payment Save and Continue Later How has this money been used?Please enter details below Save and Continue Later Dependant children's full namesChild's DetailsFirst nameLast nameDate of BirthAge Adults*Children*Total residents at this address Save and Continue Later MONTHLY INCOME - Please give Net figuresMonthly earnings (self)Monthly earnings (spouse/partner/other family members)Police Pension (self)Police Pension (children)State PensionOccupational PensionBereavement Allowance (52 weeks) / Widowed Parent's AllowancePolice Charities: Police Dependant's Trust, National Police Fund, COPS, Force Welfare/Benevolent Fund etcThe Gurney FundMaintenance Payments (including CSA)Investment Incomei.e. amount received each month not the amount investedOther Income(specify) e.g. property rental - UK and abroadOther income sourcePlease provide details Save and Continue Later BENEFITS & CREDITSPlease give monthly figuresChild BenefitStatutory Sick PayDisability Working AllowanceDisability Living AllowanceAttendance AllowanceIndustrial Injuries Disablement BenefitSevere Disablement AllowanceCouncil Tax BenefitMaternity Allowance/Statutory Maternity PayReduced Earnings Allowance (only prior to Oct 1990)Carer's Allowance Save and Continue Later Universal Credit: Please ItemiseJob Seeker's AllowanceIncapacity Benefit / Employment Support AllowanceIncome SupportChild Tax CreditWorking Tax CreditsHousing BenefitOther IncomePlease specify in large box belowOther income detailsTotal Monthly Income and Benefits Save and Continue Later Monthly ExpenditureMortgage / RentCouncil RatesProperty MaintenanceWater RatesGas / Oil / Solid FuelElectricityAssurance (life)e.g. endowment for mortgageInsurance (buildings)Insurance (contents)CSA / Maintenance PaymentsFood "housekeeping"including newspapers/toiletries/laundry etc.ClothingTelephone HomeTelephone MobileInternet / SatelliteSchool Expensese.g. meals and tripsPrivate School FeesFurther / Higher / Adult Education FeesTelevision LicenceVehicle Breakdown CoverVehicle FuelVehicle InsuranceVehicle Tax, MOT and MaintenanceNumber of VehiclesChildren's Pocket MoneyPet ExpensesChild Care / Baby SittingHairdressingRegular Subscriptionse.g. Union feesHobbies / Leisure / SportPublic Transporte.g. trains, school busMedical / Dental / Glasses/ LensesOther ExpensesPlease provide details belowOther Expenses Detailsplease provide a break down of your other expenses aboveTotal Monthly Expenditure Save and Continue Later ADDITIONAL MONTHLY CREDIT COMMITMENTSe.g. Hire Purchase Agreemenrs, Loans - car, bank, etc). Do not include items listed under "Monthly Expenditure"Purchase DetailsDetailsAmount per monthDate of final payment Save and Continue Later And finally, if you wish to apply for assistance with educational expenditure, please attach receipts.Please upload scans Drop files here or Save and Continue Later This iframe contains the logic required to handle AJAX powered Gravity Forms.