Beneficiary Form

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Beneficiary Form

Thank You for Contacting UR-Rahman Foodbank UK
We appreciate your interest in reaching out to UR-Rahman Foodbank UK.

Please note: We currently provide food groceries and essential items, subject to availability. Unfortunately, we do not assist with other matters.

Important – Please Read Carefully

Before sharing any personal information, kindly ensure that you have read and understood the following:

UR-Rahman Foodbank UK is registered with the Information Commissioner’s Office (ICO) for data protection purposes.

Food Allergy or Intolerance? Terms & Condition always apply to use the services of foodbank Ur Rahman.

For more Please Visit Our Website:https://ur-rahmanfoodbank.co.uk/food-allergies-terms-and-conditions/

Organization Name: UR RAHMAN FB UK LTD

ICO Registration Reference: ZB917020

All personal information shared with us will be kept confidential and secure, used only for foodbank operations.

Name *

Age *

Gender *

Male

Female

Prefer not to say

Country of birth *

YYYY

Citizenship *

Religion *

Phone Number
*

National Insurance Number *

Email Address *

Address *

Total number of people in your household

Number of children in the household

Do you have any elderly or disabled dependents living with you?

Yes

Clear selection

Are you a single-parent household?

Yes

Clear selection

What is your current employment status?

Employed full-time

Employed part-time

Self-employed

Unemployed

Student

Retired

Unable to work due to illness/disability

Clear selection

What is your total household monthly income (after tax)?

Less than £1,000

£1,000 – £1,500

£1,501 – £2,000

£2,001 – £2,500

£2,501 – £3,000

Over £3,000

Clear selection

Are you currently facing financial hardship?

Struggling to afford rent/mortgage

Difficulty buying groceries

In debt

Recently lost a job

Reduced work hours

Other:

Clear selection

Are you currently receiving any of the following benefits/support?

Universal Credit

Income Support

Jobseeker’s Allowance

Child Benefit

Housing Benefit

Personal Independence Payment (PIP)

Carer’s Allowance

Disability Living Allowance (DLA)

No access to public funds

None of the above

Other:

What is your current housing situation?

Renting (private)

Renting (council/housing association)

Homeowner

Staying with family/friends

Temporary accommodation

At risk of eviction

Homeless

Other:

Clear selection

Is your home overcrowded or unsafe?

Yes

Clear selection

Do you or anyone in your household have a chronic illness or disability?

Yes

Prefer not to say

Clear selection

Do you have significant ongoing medical expenses?

Yes

Clear selection

Have you experienced any of the following in the past 6 months?

Job loss

Domestic abuse or violence

Bereavement

Asylum seeker/refugee status

Recent arrival to the UK

Natural disaster / fire / flood displacement

None of the above

Other:

Is there anything else you would like us to know about your current situation?

How did you find out about our foodbank ?

Once you have completed and submitted the beneficiary form, please WhatsApp your photo ID — this can be a passport, driving license, or citizenship card.

If you submit a form, please take a screenshot and share it on WhatsApp.

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If you submit a form, please take a screenshot and share it on WhatsApp.

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