Year 3 Hosted Bank Account Form

Communities Mental Health and Wellbeing Fund

Hosted Bank Account Information
Form to be completed by the organisation who is kindly hosting the grant on behalf of the organisation applying to the above fund.
Your Organisation Name*
Email*
Contact email address
Address *

Address Line 1

Address Line 2

CityCounty

Postcode
To Whom It May Concern

RE: Access to a Bank Account not belonging to the organisation that is applying to the Communities Mental Health and Wellbeing Fund
Declaration Statement*

I declare that I have the authority to allow the use of a bank account operated by the named hosting organisation (named above) for the purpose of enabling another group (named below) to apply for a grant from the Communities Mental Health and Wellbeing Fund.I declare that I am authorising the use of such a bank account for the purpose described above.I declare that where it has been deemed necessary by the Directors and/or Trustees of the hosting organisation, there is an agreement in place between the two organisations/groups named below.I declare that the organisation providing the bank account understands that neither ACVO, its staff, or any external assessment panel member can be held responsible for any loss (real or perceived) should the sharing arrangement between the two organisations/groups deteriorate at any point in time following the depositing of funds.
Name of the group seeking the support of a bank account*
Bank account name - exactly as shown on a bank statement*
Bank account sortcode*
00-00-00
Bank account number*
Normally 8 digits
Your name *

First NameLast Name
Your role within the organisation/group*
Signature*

Clear
Date of signing
Should be Empty:

Communities Mental Health and Wellbeing Fund