ASCL Benevolent Fund Request Form

To request assistance from ASCL Benevolent Fund, please complete the below form and submit. Once received, your details will be sent to the Benevolent Fund Trustees and one of the Trustees will contact you.

Full name:
Preferred contact number:
Email address:
Home address:
ASCL Membership Number (if known):
Region:
ASCL Benevolent Fund Trustees would like your consent to use the above information relating to awards and the services and support that we provide. Our Privacy Notice is available here.
Do you consent to having your details processed?:	Yes No
Do you have an active case with ASCL's Member Support team?:	Yes No
If yes, please provide the name of the ASCL officer dealing with your case:
Please provide a brief summary of your request for assistance:
Security code: