Matched Funding Form

* Mandatory fields.

Full Name * : *

Job Title * : *

Email Address * : * Invalid Email!!

Telephone Number * : * Invalid Telephone number!!

Operating Company * : Aircoach Avanti West Coast First Aberdeen FCC First Cymru First Eastern Counties First Essex First Glasgow First Hampshire, Dorset & Berkshire First Manchester First Midlands & Potteries First Travel Solutions First Scotland East First South West First South Yorkshire & York First West of England First West Yorkshire FirstGroup Hull Trains Great Western Railway South Western Railway Tram Operations Ltd. Lumo TransPennine Express *

Line Manager Name * : *

Line Manager Job Title * : *

Line Manager Email Address * : * Invalid Email!!

Number of total team members : Invalid number!!

Number of team members who work for FirstGroup : Invalid number!!

Names of team members who work for FirstGroup :

* Team applications are restricted to a maximum of 4 FirstGroup employees (ie team applications cannot exceed £800 or Euro equivalent)

Charity Name * : *

Charity Registration Number * :
(This is usually found in the footer on the charity website, or on the Charity Commission website) *

Charity Bank Account Number * : *

Charity Bank Sort Code * : *

Charity Bank Name * : *

Which category does your chosen charity fall under? * : Arts & Culture Economic Development Education Emergency Relief Environment Health Other Social Welfare Railway Children Samaritans *

Type of Event * : Abseil Bake Sale Climbing or hiking challenge Cycle challenge Movember Quiz or Bingo Event Raffle Running challenge Skydive Other sporting challenge Other *

Date of Event * : * Invalid Date!!

Total amount fundraised by yourself, or, if doing a team application, all 4 team members who work for FirstGroup in £ * : * Invalid number!!

Amount to be matched in £ (this can be between £50 per year and £200 per year, or the Euro quivalent, per individual - or a maximum of £800 for Team applications - and will be rounded down to the nearest pound) * : * Invalid number!!

For online fundraising, please provide the full url here (eg www/justgiving.com/…) :

For offline fundraising, please attach evidence of your fundraising amount (eg photo of a paying in slip or letter of acknowledgement from the charity) :

Reference to be included in payment :

How did you hear about Matched Funding? : Benefits brochure Colleague Community First Employee Director Employee Portal HR Internal Communications Manager Notice board or poster Previous application Word of mouth Other

Please click to confirm you have read the Matching Guidelines *: *

By clicking here, I agree that the information provided in this application is true and correct. I understand that any false or misleading statement or significant omission may disqualify me from applying to the Matched Funding Scheme. I consent to the above data being held, analysed and processed by FirstGroup and Charitable Giving (for payment to my chosen charity).*: *