APPLICATION FOR ASSISTANCE

All information provided in this form is strictly confidential.

First Name *

Last Name *

Email *

Address *

Suburb *

State *

Postcode *

Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte D'ivoire (Ivory Coast) Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Monserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (Great Britain) United States Minor Outlying Islands United States of America United States Virgin Islands Unknown or unspecified country Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands, British Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe

Date of Birth *

Phone *

MEAA Membership Number (If Applicable) 

Amount Requested *

Please supply a brief summary of the reason you require assistance *

Your annual income from: Salary *

Your annual income from: Pension *

Your annual income from: Benefits *

Your annual income from: Investments *

Your annual income from: Other *

Total Annual Income *

Value of your: Savings *

Value of your: Property *

Value of your: Car *

Value of your: Shares/Managed Funds *

Value of your: Other assets *

TOTAL ASSET VALUE *

Your monthly expenses: Rent/Mortgage *

Your monthly expenses:  Food *

Your monthly expenses:  Car *

Your monthly expenses:  Utilities *

Your monthly expenses:  General Expenses *

Your monthly expenses:  Debt Repayments *

Your monthly expenses:  Other expenses *

TOTAL MONTHLY EXPENSES *

Do you  live with a partner? YES NO

I have dependents

To help us assess your application, please describe to us your illness, disability, accident and/or any other detail relating to the reasons for your request for assistance.  *

I understand that the details in this application are confidential and will never be made public. The Actors Benevolent Fund of NSW on behalf of the Actors Benevolent Fund reserves the right to make discreet enquiries about the information provided.   *

I also understand that, should I be granted assistance, I will inform the Actors Benevolent Fund of any changes to my current circumstances which may affect my eligibility for assistance. I also undertake to provide the Fund with any updated information as may be requested from time to time. *

Submit Submit Submit

* PLEASE NOTE: There will be a Verification Process that will appear after you click SUBMIT. The page will change in shade - scroll up to the top of the page to view the verification window to complete your application.

Grant applications will be presented to the Actors Benevolent Fund of NSW’s Management Committee at their monthly meetings, held on the final Monday of each month.

The Actors Benevolent Fund of NSW is able to offer small measures to help relieve pressure for members of the performing arts community during this period of crisis. Due to the limitation of available funds and expected need, all support is given at the discretion of the management committee of ABFNSW. 

* Mental health support is offered in addition to the complimentary services accessible through NSW Health Plan. Please speak to your GP about how to access this plan before requesting assistance. We can assist if you need urgent support before the complimentary service becomes available. Please let us know the expected start date for treatment.