Chasdei Efrat

What kind of assistance do you need?*

Holiday Help

Other Assistance

Last name*

First name*

Teudat Zehut/ID Card Number*

Please upload a photo of your Teudat Zehut (ID Card) and the Sefach (Appendix)*

Drop files here or

Max. file size: 256 MB.

Date of birth*

Address*

Phone number*

Additional phone number

Email*

Gender*

Male

Female

Place of employment*

Job Description

Marital status*

Spouse

Last name*

First name*

Teudat Zehut/ID Card Number*

Please upload a photo of your Teudat Zehut (ID Card) and the Sefach (Appendix)*

Drop files here or

Max. file size: 256 MB.

Date of birth*

Address*

Phone number*

Additional Phone number

Email*

Place of employment*

Job Description

Additional Household Members

Name

Year of birth

T.Z. number

Occupation

Monthly Income

Lives at home

Monthly Income for Household (in NIS)

Workplace net income*

Bituah Leumi (child allowance, disability payments)*

Child Support (Mezonot)*

Monthly help from family or friends*

Other income (rental, pensions, investments)*

Monthly income from abroad*

Your monthly income (in NIS)

Workplace net income*

Bituah Leumi (child allowance, disability payments)*

Child Support (Mezonot)*

Monthly help from family or friends*

Monthly income from abroad*

Other income (rental, pensions, investments)*

Spouse's monthly income (in NIS)

Workplace net income*

Bituah Leumi (child allowance, disability payments)*

Mezonot (child support)*

Monthly help from family or friends*

Monthly income from abroad*

Other income (rental, pensions, investments)*

Estimated monthly expenses (in NIS)

Rent*

Education*

Car expenses (gas, insurance, upkeep)*

Mortgage*

Chugim*

Clothing*

Insurance*

Medical*

Arnona / Water / Security*

Groceries*

Electricity*

Maintenance*

Other

Upload Files*

Please submit pay stubs, credit card statements and bank statements from the last 3 months. If you receive assistance from Bituach Leumi (National Insurance), add the last 3 statements from them too.

Drop files here or

Max. file size: 256 MB.

Discounts

Do you receive an Arnona discount?

Yes

How much is your Arnona bill after the discount?*

What percentage is the discount?

Do you receive a tuition discount?*

Yes

How much is your tuition after the discount?*

What percentage is the discount?

Please list assets owned in Israel and abroad (real estate, bank accounts, etc.).

House/Apartment*

Car/s*

Other/s*

Spouse

Monthly Income for Household (in NIS)

Your monthly income (in NIS)

Spouse's monthly income (in NIS)

Estimated monthly expenses (in NIS)

Discounts

Please list assets owned in Israel and abroad (real estate, bank accounts, etc.).

Do you have any outstanding loans? If yes, please specify.