Submit an eligibility enquiry | Baily Thomas Provident Fund

Complete this form and submit an eligibility enquiry for yourself or on behalf of someone you know.

This is required so that our staff can confirm eligibility to apply for a grant before an application can be made. This will include checking the employee's information against the database we hold of employees of Mansfield Brewery plc which was passed to the Baily Thomas Provident Fund at the time of its closure. In some cases, we verify employment with a third party organisation such as Her Majesty's Customs & Excise (HMRC) in order to determine eligibility.

Please make sure you have all the information you need before you start to complete the form as it is not possible to save the form and return to it later.

This form should not be used by beneficiaries that have accessed the trust previously and know that they are eligible to apply. Instead, use our email address enquiries@bailythomasprovidentfund.org.uk to contact us.

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Applicant details

Name *

Address

Address line 1 *

Address line 2

Town *

County *

Post code

Email address *

Telephone number

Date of birth

Day

Month

Year

National Insurance (NI) number *

Details of employment

Name of establishment

Start date of employment

Day

Month

Year

End date of employment

Day

Month

Year

Applicant status

Applicant status *

Application made by a former employee

Application made by dependent of former employee

Application made on behalf of a former employee

Your details

Your name

Your email address

Your telephone number