BDA Benevolent Fund - Dependent Application Form

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)

Application Submitted As

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.

Applicant details

Title

Other (Please specify title)

First Name

Last Name

Address

Town/City

County

Postcode

Contact Number

Email Address

Date of Birth

Other Information

I identify my gender as

Other (Please specify gender)

Please provide the current General Dental Council (GDC) number of the dentist whose income you are dependent on.

If the person you are dependent upon is no longer registered as a dentist with the GDC, please provide some evidence e.g. a registration certificate. This is to demonstrate that they were a dentist so we can verify you are eligible to access financial assistance.

We will also need evidence you are or were dependent on that person. This can be a marriage certificate or a birth certificate for your children.

Supporting Evidence

Important Requirements:

File format: The document must a PDF file. We cannot accept Excel files, photos, or screenshots.

Note: If you do not provide the required documents in the correct format your application form cannot be considered. Please contact us on 0207 4864994 or info@bdabenevolentfund.org.uk if you have any queries.

Your Household

Do you have a partner?

Marital Status

Spouse/Partners Occupation

Do you live with anyone in your household?

YesNo

How many people?

Person relationship to you

Age

Is this person dependent on your income

Yes

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

YesNo

How many people?

Dependent relationship to you

Age

Employment

Current Employment (if applicable)

Current Job title

Address

Date of employment

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

Previous Job title

Address

Dates of employment

Financial Information - Assets

Do you live in rented accommodation?

YesNo

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

YesNo

Property Cost

£

Date of purchase

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

Vehicle Original Cost

£

Date of purchase

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	Monthly Payment - Partner
Current Account	£	£	1 Add another
Current Account	£	£	2 Add another
Current Account	£	£	3 Add another
Current Account	£	£
	£	£	£

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.

Financial Information - Debts

Debts/Liabilities (money owed)

	Overall outstanding amount	Monthly Payment - You	Monthly Payment - Partner
Current account overdraft	£	£	£
Other account overdraft	£	£	£
Bank Loan	£	£	£
Bank 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	£	£	£
	£	£	£

Current Monthly Income

	You	Partner
Salary 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 (Please list which ones below)	£	£
NHS Pension	£	£
Payments from charities	£	£
Other income (Please list more detail below)	£	£
	£	£

Other Benefits

Other Income

Current 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	£
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 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 TOTAL AMOUNT *	£	£
Furniture and Appliance Rental	£	£
Hobbies, Leisure or Sport	£	£
Food and Housekeeping	£ e.g. food, drinks, cleaning, school meals, meals at work, laundry and toiletries	£
	£	£

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

What assistance are you seeking and why?

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

Difficulties within your relationship or with your family

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

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

Other

Further details of physical or mental health

Further details of relationship difficulties

Further details of work difficulties

Further details of money difficulties

Further details of any other difficulties

What do you feel that the BDA Benevolent Fund can do to assist you? Please be clear about what your needs are and consider this against how we help (as detailed in the guidance notes video)?

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.If yes, please indicate which ones and the support you have been offered

Have you sought advice from any other professional person or organisation?

YesNo

Please detail the name of the charity, the date(s) you applied and the support you have been offered (if applicable)If yes, please indicate which ones and the support you have been offered

Permissions and declarations

The BDA Benevolent Fund is committed to safeguarding your privacy and will take every precaution to ensure your information is handled in line with data protection law. Your information will remain confidential and used only to assess your application, except where we are legally or professionally required to share it (for example with regulators, your university, Action Fraud, or the police). Please note, Artificial Intelligence (AI) may be used in the processing of your application.

Declarations

By ticking the box, I confirm that:

The information I have provided in this form, and any supporting documents, is accurate and truthful. This is in line with Principle 1.3 of the GDC’s Standards for the Dental Team, which requires registrants to act with integrity and not to 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 provide requested supporting 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/ University or relevant professional body, and to the police or other appropriate authorities.

I will notify the BDA Benevolent Fund of any changes in my circumstances during this process.

I consent to my personal data being processed and stored by the BDA Benevolent Fund for the purposes of administering my application. This may include special category data (such as health information), which will be processed in accordance with the UK GDPR where necessary and with my explicit consent.

My form and supporting information will be retained in line with the BDA Benevolent Fund’s retention policy, which is available on the website or on request from the office.

I confirm that I have read and understood this declaration.

Residency

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

UKOther

Please state the country/ies if other:

To help us please confirm the following

How did you hear about our services?

Other (Please specify)

What is the main reason for your application?

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.