Westbury Town Council Grant Aid Application Form

Westbury Town Council Grant Aid Application Form - 2016 Page 5

DECLARATION

I declare that:

I have read and accepted the Guidance Notes and Conditions of Funding and have answered all

questions fully and truthfully. I also declare that any grant made will be used solely for the

purpose outlined in this application.

Westbury Town Council will be recognised on any materials produced and in any form of

publicity as result of this grant.

I understand that:

Westbury Town Council reserves the right to request a list of names and addresses of members

of your organisation.

Any materials produced, made, originated, developed or arising out of the provision of the grant

are to be made available for use by the Town Council if requested.

Westbury Town Council may ask for additional information at any stage of the application

process. I will be required to submit details showing how the grant funding was used. Westbury

Town Council reserves the right to reclaim the grant in the event of it not being used for the

purpose specified.

The application form and supporting information will be copied and placed on the public agenda

for Town Council meetings. Personal data that has been supplied will not be disclosed and will

be held by Westbury Town Council in accordance with the Data Protection Act.

Name:

Position:

If using a paper application

Signature:

Date:

sign.

If submitting electronically

please enter your full name

in CAPS, personal home

address and e-mail

address. Note that this

constitutes your electronic

agreement to our terms for

the sake of this application.

Choose Number.

Page 5 of 7

Westbury Town Council Grant Aid Application Form - 2016 Page 5