Payment Application

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Details of the Host

Details of the Host

Title
First Name null
Surname null
Date of Birth null
Email address null
Daytime phone number null

Your address :

Please enter the postcode and select the address from the drop-down list.

Your address :

Please enter the postcode and select the address from the drop-down list.

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Change

Your selected address

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Address null

Details of Lead Guest

Details of Lead Guest

First Name null
Surname null
Date of Birth null

Details of where they are staying:

Please enter the postcode of the address for where your guests will be staying and then select the address from the drop-down list

Details of where they are staying:

Please enter the postcode of the address for where your guests will be staying and then select the address from the drop-down list

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Change

Your selected address

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Address
Date arrived at the above address null

Please provide the following information

Please provide the following information

Has the above address been inspected by Rugby Borough Council?
Has the above address been inspected by Rugby Borough Council? null
Date of inspection null

A payment cannot be requested until the accommodation has been inspected and approved as suitable. Please contact homesforukraine@rugby.gov.uk to arrange a visit and then submit a further application.

A payment cannot be requested until the accommodation has been inspected and approved as suitable. Please contact homesforukraine@rugby.gov.uk to arrange a visit and then submit a further application.

Bank Account details

Please provide details of the bank or Building Society Account that you wish payments to be made into. Please note that this must be in your name

Bank Account details

Please provide details of the bank or Building Society Account that you wish payments to be made into. Please note that this must be in your name

Name of Bank / Building Society null
Name on account null
Sort code Please enter in the format NN-NN-NN null
Account Number This should be an eight digit number null
Building Society roll number
Please upload a copy of your most recent statement for this account to confirm payment details. A payment can not be made until a copy of the bank statement confirming the account details you would like the payment made too is received null

Declaration

I confirm that the information is true and accurate. I agree that the Council may check information contained in this application with other information held within the Council or by other government departments as allowed by law.

I understand that;
•    I must inform the Council if the guests move out. Any overpayment of the payment will be repayable.
•    I must inform the Council of any changes to the account for future payments to be made into and this notification must be received by the Council at least 14 days before the next payment is due.

Declaration

I confirm that the information is true and accurate. I agree that the Council may check information contained in this application with other information held within the Council or by other government departments as allowed by law.

I understand that;
•    I must inform the Council if the guests move out. Any overpayment of the payment will be repayable.
•    I must inform the Council of any changes to the account for future payments to be made into and this notification must be received by the Council at least 14 days before the next payment is due.

Do you agree to this declaration?
Do you agree to this declaration? If you have selected ‘no’, therefore a payment cannot be made to you null
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