Disaster Rapid Relief Assistance

Masonic Fund of Benevolence

Disaster Rapid Relief Assistance

For assistance completing the form, or for clarification / support, please contact UGLQ Membership on: 07 32293533 during normal business hours.If after hours: Contact John Woodford on Mobile No: 0424 144 687MFOB Pty Ltd. Email: enquiries@mfob.com.au

Applicant Details

Applicant Name

Date of birth

Mobile

Landline

Address

Spouse / Partner Details

How many people in your household have been adversely affected?

Details of the Event

Event Type

Describe how your circumstances have been adversely affected:

Verification Details

Do you have a UGLQ Masonic Connection ? e.g. You , Father , Brother, Uncle is a Mason.

Yes No

Name of Masonic Connection

Lodge Name

Lodge #

Other Orders

Please provide your bank details :

Bank Name

Account Name

BSB

Account Number

I acknowledge that I have read and understand the Masonic Fund of Benevolence Privacy Statement

Applicant Name

Signature

Submission Date

Disaster Rapid Relief Assistance

Masonic Fund of Benevolence