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Member Support Fund

LV= Green Heart Foundation

Part of the

Application form

Once you’ve completed the form below it’ll be submitted straight to the membership team at LV=. Alternatively you can print a copy of the form and post it to the address in section 7.

Before you complete the form, please read Section 6. We may need to phone or email you for more information.

* Required information

Section 1. Who is the grant for?

You can apply to the Member Support Fund for yourself (as a member of LV=) or one of your immediate family. This could include a spouse, partner, parent, child or grandchild.

Who needs help? *

Section 2. About you
Date of birth *

Have you applied for a grant from the Member Support Fund before? *

Section 3. Household income

Please tell us the following information for your household (including anyone else living in your home)

Do you: *

Section 4. Medical information
Section 5. How can we help you
Section 6. Important information you should know

The LV= Member Support Fund is designed to help LV= members who are going through a hard time and need a helping hand. It is also possible for LV= members to ask for support for one of their family who is having a tough time.

To apply for a grant you must have been a member of LV= for a continuous period of 12 months. This means you will have held a member qualifying product* with LV= for at least a year.

  • A panel will look at requests and decide if LV= can help and to what degree.
  • The panel's decision is final and we cannot explain the reason for any decisions.
  • Help might be in the form of a cheque, vouchers, a piece of equipment or something else.
  • To aid in the panel’s work please fill in as much information as you can.
  • You can send us supporting information if you wish, by post or email. See Section 7.
  • If we need more information we might get in touch with you by phone or email so it is important that you give us your contact details.
  • We will aim to make our decision as quickly as possible, and within 21 days.
  • You should only request support once, as repeat requests may be denied.

I confirm that all the information supplied is complete and correct to the best of my knowledge, and agree that Liverpool Victoria Friendly Society Limited (LVFS) or its appointed agents may make such enquiries and seek references and information such as are required to verify this request. I understand that LVFS will not use any of the information supplied on this application for any purposes other than those in connection with this request, and that under the Data Protection Act 1998. I have a right of access to my personal records held by LV=.

* Member qualifying products are usually long-term policies such as savings, investment, protection or retirement policies.

Date *

Section 7. Next steps

Please submit your request by clicking the submit button below, or post your request form to:

Freepost,
RRTS–YJCT–KCHA,
LV= Membership Team,
LV= County Gates,
Bournemouth,
BH1 2NF