Phone: 07429 681278 Charity No:1196690 Email:enquiries@pifgiftvouchers.org

Providing essential evouchers to people in crisis.

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Phone: 07429 681278 Charity No:1196690 Email:enquiries@pifgiftvouchers.org

Providing essential evouchers to people in crisis.

Donate

Person in Need Request Form

Number of person on waiting list asking for help: 44

Number of request forms received to date: 525

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- Step 1 of 4

🔊 Need help? Click the button below to hear the instructions for this form.

How are you verifying your request?

I will upload my own bank statement/benefits letter.
A Trusted Partner (Social Worker/Charity) is referring me.

Date *

YOUR DETAILS

Name *

First

Last

Mobile Number *

Are you on WhatsApp *

How do you want to receive an evoucher - if you are lucky enough to be sent one? *

Email
text

Confirm Email

Address 1

Address 2 [optional] *

Are .net Are

Town *

Post Code *

Save and Resume Later

ABOUT THE VOUCHER

Which shop would you like a voucher for? *

Aldi - instore only
Asda - online as well
Boots - online only
B&M - instore only
Costa - instore only
Farmfoods -instore only
Greggs - instore only
Iceland - instore only
Matalan - online as well
Morrissons - instore only
Primark* - instore only - MUST BE PRINTED, not on phone
Sainsbury's Grocery Only - instore only
Tesco - instore only

Amount

£10

Do you want to shop online with it? *

Please give a brief reason for the request *

What are you planning to buy? *

What difference will this evoucher make to your day to day living? *

I understand that this evoucher is a one-off for essentials *

I understand

We don't provide regular ongoing support due to insufficient funds

Please be aware that I will ask to see the receipt or a photo of the shopping. *

I agree to send a photo of the receipt or shopping

Is the voucher for *

single person
single parent
Family [2 parents & 2 or more children)

Bank statement (full page and contains your name and address) *

Drag & Drop Files, Choose Files to Upload

📸 Photo Tips for Fast Approval:

Place the paper on a flat, dark surface.
Ensure your Name and Date are clear.
Avoid using a camera flash (it causes glare).

📸 Quick Tip for a Faster Application:

Good Lighting: Place your statement on a flat surface near a window.
Avoid Blur: Hold your phone steady and tap the screen to focus on the text.
Full Page: Make sure we can see your Full Name, Address, and the Date.
File Size: If the file is too big, try taking the photo from slightly further away and cropping it, or use a "Low Quality" camera setting.

Second form of evidence (Must be the full page and must include your name and address. If you are have a child, please provide evidence.

Child benefit letter
Universal Credit [UC] letter
Referral letter from support worker
*Confirmation of PIP/Disability Living Allowance
Other

You must show the full document.

File Upload *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

📸 Photo Tips for Fast Approval:

Place the paper on a flat, dark surface.
Ensure your Name and Date are clear.
Avoid using a camera flash (it causes glare).

📸 Quick Tip for a Faster Application:

Good Lighting: Place your statement on a flat surface near a window.
Avoid Blur: Hold your phone steady and tap the screen to focus on the text.
Full Page: Make sure we can see your Full Name, Address, and the Date.
File Size: If the file is too big, try taking the photo from slightly further away and cropping it, or use a "Low Quality" camera setting.

When do you next get paid? *

Save and Resume Later

General

Are you homeless?

Have you seen https://streetsupport.net/

Are you/were you a member of the armed forces? *

No
Army
Coast Guard
Marines
Navy

Copy of Armed Services certificate

Drag & Drop Files, Choose Files to Upload

How did you hear about the scheme? *

Online search
Through a supported organisation
NHS
Other

Which hospital?

Addenbrookes
Papworth
Peterborough Ciity

If NHS please provide .net email address

NHS evidence

Drag & Drop Files, Choose Files to Upload

If you don't have an nhs.net account, please attach a pic of your NHS badge.

Which organisation/support group

Referrer's organisation

Referrer's name

First

Last

Referrer's email

Referrer's number

Other way you heard about scheme?

If mental health worker please provide letter or ask them to contact me directly to refer you. I will ask for the evidence

Which web browser did you use

Duck Duck Go
Edge
Firefox
Google
Other

Other browser

Have you been to a foodbank? *

Have you been to a foodbank? If so, which one?

Have you asked for help from other organisations in the past? *

Other help you've had

What have you done or are doing to help yourself?

Cook meals from scratch
Freeze meals
Looking for a job - Maybe register your c.v. on https://www.cv-library.co.uk/ ,
Make bulk meals
Search online for vouchers
Visit Money Saving Expert
Visit My Voucher Codes
Other

Other ways you are supporting yourself

Do you have a mobile phone? *

Are you *

Contract
Pay As You Go

How much do you pay a month?

Upto £10
£10 -£20
£20+

Who is your sim with?

Giffgaff
Smarty
Other

Other

THE IMPORTANT BIT!

Sorry, I can't accept the form without proof of name and address.

I confirm that the evidence I uploaded has my name and address on it. *

Yes, it has
No, it hasn't

Are you willing to nominate the scheme to give us a chance of winning £1000? *

Yes
Rather not

Please visit https://movementforgood.com/#nominateACharity

Do you or anyone you know shop online? *

https://join.easyfundraising.org.uk/payitforwardvouchersscheme/YXMBJA/c2s/2sfdSxpE/CE973/facebook//

Please share this link with anyone who shops online. It will help boost our funds.

Voucher given [for admin use only]

I'm happy to fill in a feedback form *

I agree

The feedback form is vital for us, as it's helps us request more financial donations

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

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Address

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City

State

Zip Code

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Email *

Registered Charity No.: 1196690

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Mobile: 07429 6781278
Email: enquiries@pifgiftvouchers.org

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