Your form reference is
CGVJMMZX
Please complete the details below
Title
Mrs
What’s your first name?
Sagda
What’s your last name (family name)?
Ezzeddin
Date of birth (DD/MM/YYYY) (It is critical you enter your correct details here, please double check them before moving on)
28/03/1995
What’s your National Insurance Number (NINO)? It is critical you enter your correct details here, please double check them before moving on
SE024103D
Email address
It is critical that you check and double check your email. Because this is the way we will automatically notify you and the quickest way for us to contact you if
we have a query. The email address must be your own and not a third parties. If you do not have an email address, please visit a library where they can assist
you to apply.
[email protected]
What is the best number to phone you on?
07508282663
Are you filling in this form yourself?
Yes
No
Address
Type your postcode
Page 1 of 7
Address line 1
30
Address line 2
LEE CRESCENT
Address line 3
MANCHESTER
Address line 4
Postcode
M32 0TN
Universal Credit
Are you waiting to hear about an application for Universal Credit?
Yes
No
Page 2 of 7
Your form reference is
CGVJMMZX
About your household
Your Partner
Do you have a partner living with you?
Yes
No
Other Adults
Do you have any other adults over 18 living with you?
Yes
No
Children
Do you have any children living with you?
Yes
No
What is their first name?
Ibrahim
What is their last name (surname)?
Page 3 of 7
Albakai
What is their date of birth?
26/03/2022
Page 4 of 7
Your form reference is
CGVJMMZX
Disability Allowance
Does anyone in your household have a disability?
Yes
No
Are you a care leaver?
Yes
No
Page 5 of 7
Your form reference is
CGVJMMZX
Assistance
This is a one off award per household.
Application for food and fuel
Payment Details
We will generally make payments directly to your bank account. Do you have a bank account?
Yes
No
Please provide your bank account number
32260158
Please provide your bank Sort Code (e.g. 40-40-40)
40-11-92
It can take up to 3 working days for your bank to process your payment. If you are in an emergency situation and therefore cannot wait 3 days, please select no. If your
application is successful we will send you a voucher instead.
BACS payments can only be made into the applicants bank account. If the account details you have provided do not belong to the applicant.
Further checks will be made and the payment could be refused.
Page 6 of 7
Your form reference is
CGVJMMZX
Declaration
Declaration
By submitting this claim you are agreeing to the following declaration.
Online Declaration
I understand that if I give information which is incorrect or incomplete, action may be taken against me. This may include court action.
I understand you will check my eligibility by comparing the information I have provided against data already held by Trafford Council.
I understand that once my application is submitted you may delay or stop my payment if there are discrepancies in the information I have provided and Trafford
Council records.
I understand you may ask for additional information before a payment is made.
You will use the information I have provided to process my claim for Trafford Assist.
You may check some of the information with other sources as allowed by the law.
You may use any information I have provided in connection with this and any other claim for social security benefits that I have made or may make. You may give
some information to other organisations such as government departments, local authorities and private sector companies such as banks and organisations which may
lend me money, if the law allows this.
I know I must let the Council know straight away about any changes which may affect my entitlement.
I understand that you may use automated processes to check my eligibility.
Trafford Council is under a duty to protect public funds it administers, and to this end may use the information on this form for the prevention and detection of fraud. For
further information please see our privacy statement.
I/we declare that the information I/we have given on this form is correct and complete to the best of my/our knowledge. If there are any other changes
I/we will let you know straight away.
Now submit your form using the submit button below.
Page 7 of 7
