1. Personal details

Fill in the personal details of the person to whom the application relates.

2. Report your financial situation

2.1 Fill in if you and your partner have income in the form of salary from employment or grants/allowances from other authorities or organisations, such as sickness benefits, parental benefits, or child allowance from the Swedish Social Insurance Agency (Försäkringskassan). If the application is being submitted on behalf of a child, their parents’ income must also be filled in. Write asset amounts in numeric form.

2.2 Fill in whether you and your partner have more cash on hand than any daily allowance you receive from the Swedish Migration Agency. If the application is being submitted on behalf of a child, their parents’ cash reserves must also be filled in. Write asset amounts in numeric form.

2.3 Fill in if you and your partner have financial assets, such as a car, bank deposits in Sweden or abroad, your own company, shares, or assets abroad that you can sell to get cash. If the application is being submitted on behalf of a child, their parents’ assets must also be filled in. Write asset amounts in numeric form.

3. Signature

4. Selection of special grant package

Tick the box next to the special grant package for which you are applying. If whatever you want to pay for using the special grant does not fit into one of the package categories, move on to item 5 or item 6.

5. Application for a grant for expenses for medical care and medication

Tick the box next to what you want to apply for and then describe in as much detail as possible what the grant is needed for. Attach any receipts and prescription specifications on which the name of the applicant is stated.

6. If your need does not fit into the standard packages, describe it here

If whatever you want to pay for using a special grant does not fall into the categories outlined in item 4 or item 5, clearly describe what you need the grant for and how much money you need to be able to buy the product or service. Also describe why you need the product or service. Write which documents you are submitting with the application.