APPLICANT DECLARATION LETTER

I confirm that I have not applied for the Income Support Grant (ISG) or any other COVID-19

Relief Grant for the period May 2021.

I certify that the information supplied is true and correct in all respects and I understand that I

may be prosecuted if I have given any information that I know to be false or do not believe to be

true.

NAME: _________________________________ _______________________________________

SURNAME OTHER NAMES

ADDRESS: ____________________________________________________________________________

____________________________________________________________________________

VALID IDENTIFICATION: ( ) PASSPORT

(tick appropriate box)
( ) NATIONAL ID NUMBER: ______________________________

( ) DRIVER’S PERMIT

SIGNATURE OF APPLICANT: ____________________________________________________________

DATE: ______________________________________________________________________________