BDA Benevolent Fund - Dentists Application Form

Application Submitted As

The BDA Benevolent Fund supports dental students, dentists, and their families.

Financial Support

To access financial assistance, you must belong to one of the following categories:

Undergraduate dental student: You are currently enrolled in a BDS/BChD course (and have already started your studies).
Current or former dentist: You are, or have been, registered with the General Dental Council (GDC) as a dentist.
Asylum seeker or refugee: You are a current or former dentist (through registration, qualification, or equivalent) and hold asylum seeker or refugee status.
Dependent of a dentist: You are the spouse, partner, widow/widower, or someone responsible for the child(ren) of a dentist.

You must currently be living in the UK.

Financial aid is available to individuals who cannot meet their current personal expenses due to insufficient income from work, state support, student finance, or savings. Applicants with funds in their account exceeding £10,000 will not be considered are expected to use their own monies before applying (with the exception of funds set aside for tax).

The Charity operates independently of the British Dental Association (BDA). Membership with the BDA is not required to request assistance.

Wellbeing Support

Wellbeing support is available anonymously, for free, and at any time—no application form is necessary.

Visit our website to learn more: https://www.bdabenevolentfund.org.uk/wellbeing/, or download the Wellbeing Support for the Dental Team resource here: https://www.supportfordentalteams.org/.

If you have any questions, please contact us:

Email: info@bdabenevolentfund.org.uk
Phone: 0207 486 4994
(Office hours: Monday–Friday, 9:30 am–5:30 pm, excluding public holidays)

This form can be saved as you complete it and resumed at a later time.

Before submitting, please review all information carefully to ensure it is accurate. Inaccurate information (whether provided intentionally or unintentionally) may result in delays or a decision not to offer financial assistance.

Once submitted, you will receive an automated confirmation that your application has been received. Please note that all fields marked with an * are mandatory; applications missing this information cannot be processed.

Personal details

Title

Other (Please specify title)

First Name

Last Name

Email Address

Date of Birth

Please use the correct format with forward slashes.

Contact Number

Address

Town/City

County

Post Code

Other information

General Dental Council (GDC) Registration Number

If you are no longer registered with the GDC, please upload evidence of your prior registration at the end of the application.

What year did you qualify as a dentist?

I identify my gender as

Other (Please specify gender)

Your household

Do you have a partner?

Marital Status

Spouse/Partners Occupation

Do you live with anyone?

YesNo

How many people?

Person relationship to you

Age

Is this person dependent on your income?

How many people?

Is anyone else dependent on your income that does not live with you?

YesNo

Relationship to you

Age

Employment

Current employment (if applicable)

Current role title

Address

Date you started

Previous employment - please provide details of last 2 years of your employment history

Previous role title

Address

Start and finish dates

Financial information - assets

Do you live in rented accommodation?

YesNo

Do you /your partner own any property? This includes any mortgages

YesNoPlease tick yes if you have a mortgage, part or shared ownership etc.

Date of purchase

Property cost

£

Current value

£

Outstanding mortgage*

£

* If applicable

Years left to pay

* If applicable

Do you or your partner own any vehicles? This includes cars bought using finance i.e. hire purchase

YesNoIncluding hire purchase or conditional sale vehicles

Date of purchase

Vehicle cost

£

Current value

£

Outstanding amount left to pay*

£

* If applicable

Years left to pay*

* If applicable

Assets (money in credit)

	Total Amount - You	Total Amount - Partner
Current account	£	£	1 Add another
Current account 2	£	£	2 Add another
Current account 3	£	£	3 Add another
Current account 4	£	£
	£	£	£

For us to consider your request through this form, you must provide statements for all your accounts covering the last three months from the date of your application including credit cards.

If you are living with a partner, their bank statements must also be included. These statements are used to verify the information you have provided.

Supporting evidence

Important requirements:

File format: The statements must be submitted as a PDF file. We cannot accept Excel files, photos, or screenshots. The files should be original, not annotated.

Details included: The statements must clearly show your full name and address (transaction summaries or screenshots are not accepted for this reason).

How to Download Statements:

If you’re unsure how to download your bank statements, search online for instructions by typing your bank’s name followed by “download bank statements.”

Note: If you do not provide the required documents in the correct format your application form cannot be processed. The number of statements uploaded should reflect the details you have provided on this form i.e. if you have three current/ savings accounts, then you need to upload nine files.

Debts/ liabilities (money owed)

Detail all the information regarding the money that you owe, giving the total amount owed, and how much you are paying this back e.g. monthly or annually. This helps to give a full picture of your financial situation and also should be reflected in the information you provide on the next few pages.

	Overall outstanding amount	Monthly Payment -You	Monthly Payment-Partner
Current Account Overdraft	£	£	£
Other Account Overdraft	£	£	£
Loan	£	£	£
Loan	£	£	£
Hire Purchase	£	£	£
Credit Card	£	£	£	1 Add another
Credit Card 2	£	£	£	2 Add another
Credit Card 3	£	£	£	3 Add another
Credit Card 4	£	£	£	4 Add another
Credit Card 5	£	£	£	5 Add another
Credit Card 6	£	£	£
Store Card	£	£	£
HMRC	£	£	£
Family/Friends	£	£	£
Rent/Mortgage Arrears	£	£	£
Utility Arrears	£	£	£
Other	£	£	£
	£	£	£

Monthly income

	You	Partner
Salary/ wages i.e. earned income from working	£	£
Practice drawings	£	£
State pension	£	£
Bereavement allowance	£	£
Private pension(s)	£	£
Pension credit	£	£
Employment Support Allowance (ESA)	£	£
Housing Benefit	£	£
Working Tax Credit	£	£
Maternity Pay/Maternity Allowance	£	£
Paternity Allowance	£	£
Support for Mortgage Interest	£	£
Council Tax Reduction/Support or Rate Relief	£	£
Incapacity Benefit	£	£
Disability Living Allowance (DLA)	£	£
Personal Independent Payment (PIP)	£	£
Universal Credit (UC)	£	£
Carers Allowance	£	£
Attendance Allowance	£	£
Child Benefit	£	£
Child Tax Credit	£	£
Contributions towards Children	£	£
Other Benefits Total (Please list which ones below)	£	£
NHS Pension	£	£
Payments from charities	£	£
Other Income Total (Please list more detail below)	£	£
	£	£

Other Benefits

Other Income

Monthly expenditure

	You	Partner
Rent	£	£
Mortgage	£	£
Secured Loan	£	£
Mortgage Endowment	£	£
Service Charge/Ground Rent	£	£
Water	£	£
Council Tax	£ Including water charge if you live in Scotland and rates in NI	£ Including water charge if you live in Scotland and rates in NI
Gas	£	£
Electricity	£	£
Other Household Fuels	£	£
Telephone and Internet	£	£
Mobile	£	£
TV Licence	£	£
Other Television Bills	£	£
Buildings/Contents Insurance	£	£
Life Insurance	£	£
Childcare	£	£
Child Maintenance or Child Support	£	£
BDA or other professional membership	£	£
Car Insurance	£	£
Road Tax	£	£
MOT and Ongoing Maintenance	£	£
Petrol	£	£
Public Transport	£	£
Food and Housekeeping	£	£
Pets and Pet Insurance	£	£
Medicine/Prescriptions	£	£
Professional Fees	£	£
Indemnity	£	£
Loan Repayments	£	£
HP Repayments	£	£
Credit Card Repayments	£	£
Other Essential Living Costs (Combined Total)*	£	£
Furniture and Appliance Rental	£	£
Hobbies, Leisure or Sport	£	£
Total	£	£

*Please list what your other (essential) living costs are, if applicable

What assistance are you seeking and how can we help you?

We deal with all requests on an individual basis as no two situations are the same. We aim to tailor our grants to best match your immediate needs. We support those that are currently facing financial hardship in accordance with out Grantmaking Policy. Financial hardship is defined as having insufficient income and/ or savings to manage your current essential living costs. Please watch our guidance notes video prior to applying to see who and how we help.

Tick the relevant category/categories below and fill out the sections that are applicable to you and provide us with a summary of your current circumstances, specifically how this has led to you approaching us for financial assistance.

Difficulties due to physical or mental ill health including addiction

Further details of physical or mental health

Difficulties within your relationship or with your family

Further details of relationship difficulties

Difficulties at work e.g. with your employer, the GDC, NHS England or because of unemployment

Further details of work difficulties

Difficulties with money including unexpected expenditure, debts or problems with cash flow

Further details of financial difficulties

Other

Further details of any other difficulties

What do you feel that the BDA Benevolent Fund can do to assist you with the above? If you haven't already, please watch the guidance video to understand how we help. Please provide a detailed response (minimum 500 characters and maximum 2000 characters) in full sentences explaining the type of support you are seeking and how the BDA Benevolent Fund can assist you so that we understand why you are applying for help. Insufficient information may cause your application to be delayed or refused.

Please provide a detailed response (minimum 500 characters and maximum 2000 characters) explaining the type of support you are seeking and how the BDA Benevolent Fund can assist you.

Signposting

Have you applied to any other charities?

YesNo

Please detail the name of the person/organisation/ charity, the date(s) you contacted them and the support you were offered.

Have you sought advice from any other professional person/ organisation/ charity?

YesNo

Please detail the name of the charity, the date(s) you applied and the support you have been offered (if applicable)

Permissions and declarations

The BDA Benevolent Fund is committed to safeguarding your privacy and handles all personal information in accordance with applicable data protection legislation, including the UK GDPR and the Data Protection Act 2018. Your information will be kept confidential and used only for the purpose of assessing and administering your application, except where disclosure is required by law or professional obligation (for example to regulators, your university, Report Fraud, or the police). Artificial Intelligence (AI) tools may be used as part of our application processing procedures.

For further information about how we collect, use, retain and protect your information, including personal data, please refer to our privacy information, which is available on the website or on request.

By ticking the box, I confirm that I have read and understood this declaration:

The information provided in this form, together with any supporting documents, is accurate and truthful. This reflects Principle 1.3 of the General Dental Council’s Standards for the Dental Team, which requires registrants to act with integrity and not sign documents that are false or misleading or provide information that is dishonest. I understand that providing false, misleading, or incomplete information, including deliberately withholding relevant details or failing to supply requested documents (such as bank statements), may be considered dishonest and may result in my application being refused or withdrawn. Fraudulent applications may be reported to the General Dental Council, your university (for dental students) to the police and/ or other relevant authorities or regulators. I will notify the BDA Benevolent Fund of any changes in my circumstances during the application process. I understand that the BDA Benevolent Fund will process my personal data as necessary for assessing and administering my application. This includes processing based on legitimate interests, contractual obligations or other appropriate lawful bases under the UK GDPR, depending on the nature of the data and the processing activity. Where I choose to provide special category personal data (such as health information), I give my explicit consent for the BDA Benevolent Fund to process that information for the purposes of assessing and administering my application. I understand that I may withdraw this consent at any time, although this may affect the Charity’s ability to consider my application.

Residency

The country in the world I am resident of (for tax purposes) is

UKOther

Please state the country/ies if other:

To help us please confirm the following

What is the main reason for your application?

Other (Please specify)

How did you hear about our services?

Other (Please specify)

Please click the submit button for your application to be processed.

On the next page you will then be given the opportunity to review and edit the information in your form for a final time prior to submission. It is at this stage you are also given the option to print the form for your records, should you wish to do so. Alternatively, if you do not have access to a printer, you can save the information as a web page by right clicking 'save as' and saving it to your device (ideally as a PDF).

We aim to acknowledge all applications within 3 working days.

If relevant, we will arrange a call to learn more about your situation, to go through any queries and to explain our process.