RSPCA CORNWALL WELFARE VVETERINARY SUPPORT/CAT NEUTERING APPLICATION

Please note that any vouchers issued to you will have an expiry date by which they need to be used. If your animal is not yet ready for the procedure for which you are applying for these vouchers, please do not apply yet. This form can be used to apply for support with the cost of cat neutering or veterinary costs. We can only issue vouchers to support treatment in advance and will not refund any treatment already received and/or paid for. Please note that only partial costs can be claimed. If you have more than 2 cats and need assistance to stop the population growing, please email us on info@rspcacornwall.org.uk for advice.

*	I understand that this form applies to one animal only and that if I require a form for a second animal I will complete a separate form
I receive qualifying state benefits (see list at foot of form) and am applying for the following: *
	Please tick to confirm that you agree to your cat being neutered (payment supported by us) if being chipped
Title *
First name(s) *
Surname *
Full address *
Postcode *
Home phone
Mobile number *
Email address *
Name and address of vet practice *
Species (Dog, cat etc) *
Where did you get the animal from *
For crossbreed dogs or moggy cats please just write "crossbreed" *
Animals name *
Male or female *
Colour
If you are requesting help to pay a vet bill (not neutering or chipping) please briefly explain the nature of the complaint and treatment required.
How much has your vet quoted (please attach a copy of the vet's estimate - a clear photo will be needed)
Photo of vet estimate *
I declare and confirm I am receiving the following benefit(s)
*	I confirm I have attached ONE proof of receipt of benefit, as a clear photo, including the amount received, and dated within the last 3 months. I understand it will be returned to me.
Proof of benefit *
Signature of owner and claimant *
Date *
We would love to keep you updated about our fundraising activities, news and ways in which you can help animals. Do you wish for us to keep you updated? *
If you answered YES to the above question, please tell us how you would like to hear from us:
	Email
	Post
	Phone
	SMS

Thank you for your submission. If you are having difficulty with the form please contact info@rspcacornwall.org.uk for a PDF version, which you can print and post back to us at The Venton Centre, Quoit, St Columb TR9 6JS. Our scheme administrator will contact you with more information shortly. In the meantime please bear with us as the voucher programme is not administered via the Animal Centre at Quoit. If you have not had a response within 21 days please email info@rspcacornwall.org.uk - including the emailed copy of the form you submitted. HOW WE USE YOUR INFORMATION: RSPCA Cornwall Branch uses the personal data you give us on this and other forms for the purpose of achieving its animal welfare objectives. It is processed as a contractual necessity in order to take steps at your request prior to the entry into a contract for a service provided by the charity. The information you have supplied will be used to contact you about assisting you to pay a veterinary bill or having a cat microchipped or neutered and to maintain administrative records. It will not be passed to any other organisation. Generally we will keep your personal data only as long as needed to provide you with the services requested. Data required to be retained for compliance with legal obligations e.g. accounting records for HMRC will be retained for a minimum of six years. To ask for further information about how your personal data is used and stored, our data security and retention policies, and your right to access your data, please see the Privalcy Notice on our website at www.rspcacornwall.org.uk. Or you can write to the Admin Officer, RSPCA Cornwall Branch, The William and Patricia Venton Animal Centre, Quoit, St. Columb, TR9 6JS. For general information about data protection see: http://www.ico.gov.uk.