LE GRAND CHAPITRE DE MAÇONS DE L’ARCHE ROYALE DU QUÉBEC
THE GRAND CHAPTER OF ROYAL ARCH MASONS OF QUEBEC
ROYAL ARCH MASONS OF QUEBEC FUND
APPLICATION FOR ASSISTANCE
To be completed by the First Principal & the Scribe Ezra of the Chapter
WHEN COMPLETED. MUST BE TREATED WITH CONFIDENTIALITY
INSTRUCTIONS(Please read carefully)
Purpose: / Grants from this Fund may be made only to DISTRESSED MASONS of the Jurisdiction and those dependent upon them, or to their DISTRESSED WIDOWS.Status: / To be entitled to the benefits of this Fund. Brethren must be members in good standing of Chapters of this Jurisdiction. ln the case of widows, the foregoing qualifications are applicable to their husbands at time of death.
General: / a) All cases must be FULLY INVESTIGATED under the authority of the Chapter Benevolent Committee or of its Permanent Committee.
b) Chapters are particularly requested to exercise the greatest care in obtaining and reporting factualinformation.
c) All questions in this form must be fully answered. Leave none blank.
d) All applications for assistance must be approved by the Chapter and the resolution shall indicate the amount requested.
Chapter………………………………………………………………………..………………..…….. No. ………….
Scribe Ezra ……………………………………………………………………………………...……………………..
Address ………………………………………………………………………………………………………….…….
Telephone ………………………..…………. E-mail …………………………….…………….……………………
(1) Name of the Companion applicant or deceased: …………………………….……………………………….
(2) Occupation or status (if applicable): ………………………………………………………….…………………
(3) Is he or was he at time of death a Companion in good standing? ……………….….. Yes …… No ……
(4) Name of applicant: Widow and/or dependents:
……………………….…………..….…… Age ……..; ……………..……….……………………… Age ……..
……………………….…………..…….… Age ……..; ………………...…………………………… Age ……..
(5) Relationship with Companion: …………………………………………………………………………………
(6) Address: ……………………………………………………………………….. Tel: ………………………….
…………………………………………………………………..….. Tel: ………………………….
(7) Is the Companion, wife, dependents or widow in receipt of:
7.1Old age pension ………………………………………….Yes …… No ……$ ……….
7.2Other pension ……………………………………………. Yes …… No ……$ ……….7.3 Private income …………………………………………… Yes …… No …… $ ………. 7.4 Grants from Societies …………………………………… Yes …… No …… $ ……….
7.5Grants from Welfare Agencies ………………………….Yes …… No ……$ ……….
7.6Help from members of family …………………………… Yes …… No ……$ ……….
7.7Assistance from your Chapter or Lodge ……………….Yes …… No ……$ ……….
7.8Other financial aid ………………………………………..Yes …… No ……$ ……….
Note: If your answer is Yes to any of these questions, please indicate the amount.
(8) If not in receipt of government benefits, state why and, if eligible, what steps are being taken to obtain it.
………………………………………………………………………………………………………………….………
(9) Does the Companion, his wife or his widow own:
a) his or her home? ………………………………………………………..……….. Yes …… No ……
b) other property? …………………………………………………………..………. Yes …… No ……
If answer is Yes, give details such as location, type of property, assessed value, mortgage (if any) and, if rented, the annual net revenue.
(10) Does the Companion or widow live at present:
a) in rented quarters? ……………………………………………………………… Yes …… No ……
b) with relatives? …………………………………………………………………… Yes …… No ……
c) with others? ……………………………………………………………………… Yes …… No ……
d) in an institution or home for the aged? ……………………………………….. Yes …… No ……
(11) What assistance is the Chapter to give per month? ……………………….……………… $ ………….
It is assumed that grants in aid may be voted for a period of 12 months.
(12) Suggested amount of present application ……………………………………….…………… $ ………….
(13) Date application approved by the Chapter ………………………………………………………………….
(14) Further remarks or comments ………………………………………………………………………………..
…………………………………………………………………………………………………………………………
Date ______
______
Scribe EzraFirst Principal
Chapter Seal
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