Umsókn – Hjálparliðasjóður Sjálfsbjargar lsh

Grant Application

Please note that a condition for receiving a grant is that the applicant is a member of one of the member associations.
Self-sufficient and in need of assistance due to a mobility impairment. (See Article 2 of the fund's regulations.)

Information about the applicant

Please fill in the following information.

Applicant's Name

Social Security Number

Phone

Email address

Address

Municipality

Zip code

Bank and account number:

Member association

The applicant has

NPA agreement Payment agreement Not under contract

Do you use assistive devices (wheelchair, prosthetic limb, walker, crutches, cane, or brace)?

Yes No

Travel information

Name of assistant/aide

Purpose of the trip (group tour, leisure trip, conference trip, etc.)

Departure location: If flying internationally, please specify the airport:

Destination(s):

Travel period (departure date)

Travel period (return date)

Cost

Specify the cost being requested for the assistant:

Fare

Accommodation

Uppihald

Total

Grants

Has a grant/grants been applied for from other parties for the above-mentioned trip?

Yes No

If grants have been approved, specify the grantor(s) and the total amount:

Has the applicant previously applied for assistance from the Red Cross? If yes, when?

Has the applicant received a grant from the Relief Fund before? If yes, when?

Confirmation

Sender's name

Note that the IP address of the device filling out the application is recorded.

Sender's email address

Email address confirmation

A copy of the application will be sent to the sender's email address.

Personal information is processed in accordance with applicable privacy laws.

Application – Sjálfsbjörg National Association's Relief Fund