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If you or someone you know is interested in receiving an audio device, please complete the form below.

For more information contact sarah@blind.org.uk or phone 01622 754757.

Please note that due to staff absences no devices will be shipped until the week commencing 23 September. You are still welcome to complete the form below and your device will be with you as soon as possible.

To receive a free device, the recipient must be:

  • Resident in the UK
  • Living with Sight Loss
  • Receiving Disability Living Allowance (DLA), Personal Independent (PIP) / Attendance Allowance (AA) or Adult Disability Payment (ADP) in Scotland or receives a means-tested benefit (or parent/guardian if under 18).

 

How to use this form

Please complete the form below carefully providing as much detail as you can. If you are requesting an audio device for someone else, please complete Section 1 with your own details and Section 2 with the details of the person the device is for. If you are requesting the device for yourself, you only need to complete Section 2.

We realise some people who use our services may not have an email address. If this is the case, please use a relevant friend, relative or support worker's email.

Request an audio device

  • Section 1 - Please complete if you are referring someone else

    If you are enquiring about a radio or audio device for yourself, please go straight to section 2.
  • Name of person making this referral
  • What is your relationship to the person you are referring.
  • Landline or Mobile number
  • Email Address

  • Section 2 - Details of person receiving the radio or audio device

    Please complete this section with your details or the details of the person that the device is for.
  • Name of person you would like to receive equipment
  • DD slash MM slash YYYY
  • A contact number is required (can be any number being used on behalf of the recipient, including mobiles)
  • Hidden
    If unknown leave blank
  • Hidden
    DD slash MM slash YYYY
    If unknown leave blank
    The person is resident in the UK, living with sight loss, and receives either Personal Independent (PIP), Attendance Allowance (AA) or Adult Disability Payment (ADP) in Scotland, or receives an income-related benefit.
  • Hidden
    Please select an item from the list above
  • Hidden
    Please only select this box if the person also requires a set of headphones
    By ticking this box the recipient consents to being kept informed of our future services, events and fundraising by email. Follow this link to read the full privacy policy: https://blind.org.uk/privacy-policy/
    I understand that this set is on loan to me, but will remain the property of the British Wireless for the Blind Fund (BWBF) and is therefore returnable on demand to BWBF Head Office. I must also return the set to them if I cease to be eligible. I hereby undertake not to part with, sell, or interfere with the item in any way and I will ensure accidental damage insurance is obtained. If the set is accidentally damaged, or will not work, I undertake to notify BWBF immediately.
  • Hidden
    It’s important to us that you feel informed about our news, future developments and fundraising. We want to share with you how your amazing support helps to change the lives of visually impaired people across the UK. Occasionally we will follow up with you to ensure our service continues to meet your needs If you do not wish to be contacted, or you would like to change how we contact you, let us know at any time using the following details – mydata@blind.org.uk, 01622 754757, 10 Albion Place, Maidstone, Kent, ME14 5DZ We respect your privacy and remain committed to ethical and responsible fundraising and communications. Your details will be stored securely and we will never sell them. However, from time to time we may need to share your details with trusted partners authorised to work on our behalf such as our printers or agents (e.g. your local blind association) For further information please refer to our privacy policy – www.blind.org.uk/privacy-policy/
  • This field is for validation purposes and should be left unchanged.