<p> Red Cypher – Application Form</p><p>Personal Details</p><p>Application Number: Application Date:</p><p>Name: Date of Birth:</p><p>Address:</p><p>Post Code:</p><p>Home Telephone Mobile Telephone Number: Number:</p><p>When did you serve in Are you a member of 3RHA: the PPMA:</p><p>Reason for Application</p><p>Why do you need support?</p><p>What is the estimated cost?</p><p>Other Support</p><p>Have you notified any other Agencies? </p><p>If so when?</p><p>How much support are they providing?</p><p>1</p><p>RC Application 16 Feb 2017 Data Protection / Declaration</p><p>The information you provide is subject to the Data Protection Act 1998 (the ‘Act’) By ticking box (a) you consent to us or any organisation associated with us for processing, both manually and by electronic means, your personal data for the purposes of providing a voluntary service for the benefit of the national public as specified in our constitution; administer membership records; to fundraise and promote the interests of the charity; manage our employees and volunteers; maintain our own accounts and records. </p><p>Consent (a) Date:</p><p>Signature of Applicant: </p><p>Vice Chairman’s Comments</p><p>Decision Required By:</p><p>Appointment of Trustees to Review the Application</p><p>Appointment Name Allocated Yes/ No</p><p>Vice Chairman Mr R Lodge</p><p>Trustee Mr B T O’Neill BEM</p><p>Trustee Mr A Sheddon</p><p>Trustee Mr J Smith MBE</p><p>Vice Chairman Maj D Belam MBE RHA</p><p>Trustee Maj DM Fletcher RHA</p><p>Trustee WO1 (RSM) JJ Bulmer</p><p>Trustee Sgt Carpenter MC</p><p>2 Review Decision and Action Required</p><p>Approved/ Rejected?</p><p>Senior Appointed Trustee Date: Signature:</p><p>Payment Details (to be completed if approved)</p><p>Amount Required: </p><p>Cheques payable to:</p><p>Or BACS Details:</p><p>Bank:</p><p>Address:</p><p>Account Name:</p><p>Account No:</p><p>Sort Code:</p><p>3</p><p>RC Application 16 Feb 2017</p>