If you’re interested to live in one of our Homes, please contact your preferred Home in the first instance. You can find the contact details of our Business Relationship Managers on each of our care home pages.

If you have a general query about the admission process, you can also get in touch with Debbie Hollands, our Residents Placements Manager at dhollands@rmbi.org.uk and she will be happy to assist you.

If you are ready to apply, please find below our Resident’s Application Form which you will need to complete, alongside our Eligibility Guide, where applicable.

You can download the form or complete the online form below.

If you would like further guidance or support in completing the application form, please contact your preferred Home and the Management Team will be happy to assist you.

If you are ready to apply, please find below the application form you will need to complete, alongside our Eligibility Guide, where applicable. If you would like further guidance or support in completing the application form, please contact your preferred Home and the Management Team will be happy to assist you.

We support people with a Masonic connection, as well as people in the wider community who do not have a connection to Freemasonry. Where a Home has a waiting list of residents who wish to come into the Home, priority will always be given to Freemasons and their families, as long as we can support the person’s needs. To view a list of all our Homes before completing an application form, visit our main Homes’ Page.

Our Care Checklist section below provides some useful information for those considering the different care options, along with common FAQs. You can also find out more about what we’re doing as a charity to support our residents during these challenging times in our Safety section.

Resident Application Form
Download

Resident’s Welcome Pack
(for information) Download

Eligibility Guide
(for Freemasons) Download

Eligibility Guide (Welsh)
Download

Proof of Eligibility Form
(for Freemasons) Download

Care Services Agreement

Important Information

Please complete all sections of this application if you are applying to become a permanent resident in an RMBI Home.

For respite stays in an RMBI Home, please complete Sections 1-7 and 12 only.

An applicant’s residency cannot commence until the application form has been fully completed and signed. The outline information in this application form will enable us to process your application and we may request further information or documents to support your application.

Once an application is made, a potential resident must not dispose of any property, assets or capital, or purchase any annuity, without disclosing this to RMBI Care Co.

If you need any support or advice completing this form, please contact the Home Manager or Business Relationship Manager at your preferred Home.

Step 1 of 13 – Which Home are you applying to?

Please be aware, if the form is not fully completed, we may request further information to help us process the application.
First Choice
Second Choice

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Accommodation type required
Permanent residence
Subject to care needs assessment
- Sheltered
- Residential
- Nursing
- Dementia Support House
Please indicate when you would like to move to the Home:
Please specify move in date

Day
Month
Year
Respite stay: please indicate requested dates of stay
Hidden
From:

DD
MM
YYYY
To:

DD
MM
YYYY
How will your fees for your respite stay be funded?
If other please specify*

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a) About the applicant
Name
First Last
Hidden
Date of birth

Day
Month
Year
Address
Street Address City ZIP / Postal Code
Phone
Email
Please state how you wish to be contacted.
Tick all that apply:
- Telephone
- Post
- Email address
b) About your next of kin
Next of kin 1
First name Surname
Relationship to you
Address
Street Address City ZIP / Postal Code
Phone
Email
Next of kin 2
First name Surname
Relationship to you
Address
Street Address City ZIP / Postal Code
Phone
Email

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Please note, in regards to section 4, RMBI Care Co., through the Masonic Charitable Foundation, will make enquiries regarding the membership of the qualifying Freemason, which is one of the criteria taken into account when assessing eligibility for admission.
Choose which best describes your relationship to Freemasonry
Lodge no. of Freemason:
Province:
Wife/partner’s full name:
Wife/partner’s date of birth:

Day
Month
Year
Date of (last) marriage:

Day
Month
Year
Date of (last) husband’s death:

Day
Month
Year
Name of Freemason:

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Why do you wish to live in an RMBI Home?
Do you have any health issues: (Please provide brief details)
Please provide your GP’s details:
Full name
Full name
Address
Street Address City ZIP / Postal Code

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Please provide any other information that you consider to be relevant to your application.
Did the applicant fill in this form?
Please give details of the person who completed the form.
Full name
First
Address
Street Address City ZIP / Postal Code
Phone*
Email
Relationship to you:

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If you do not deal with your own finances, please provide the name and address of the person who does this for you.
Full name
Full name
Address
Street Address City ZIP / Postal Code
Phone
Email
Relationship to you:
If you have completed above, please provide a copy of all relevant documents.
Person to be contacted for payment of fees, if different from above.
Full name
First
Address
Street Address City ZIP / Postal Code
Phone
Email
Relationship to you:

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About your finances:
Your property
Your Property details
Full address of any property owned by you:
Select as appropriate
Estimated value in GBP:
Your share of the property:
Please detail your percentage share of the property
Please provide the details of any other parties with an interest in this property together with supporting evidence, for example, a copy of the land registry.
Upload any supporting evidence
Accepted file types: jpg, png, pdf, Max. file size: 3 MB.
If the property is subject to a mortgage please provide details of the company/persons holding the mortgage, current redemption amount (estimated) and a copy of the latest statement:
Upload copy of the latest statement
Accepted file types: jpg, png, pdf, Max. file size: 3 MB.
If you have entered into an equity release agreement for this property please provide the name of the company, the copy of this agreement and the latest statement:
Upload copy of agreement and the latest statement
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 3 MB.
If this property is currently occupied by anyone other than you, please provide their details here. This should include any partner, a relative aged over 60 years, a relative who is incapacitated or a child under 16 who you support, together with supporting documents.
Upload any supporting documents
Accepted file types: jpg, png, pdf, Max. file size: 3 MB.
Please provide similar details for any additional properties owned by you, or which you have an interest in.
Upload any more documents
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 3 MB.
RMBI Care Co. can offer a deferred payment scheme if your property needs to be taken into account as part of your care fees. If you would like more information on its deferred payment scheme, pick tick here. Your LA may also offer a deferred payment scheme; please contact them directly for more information. Please note that RMBI Care Co.’s full weekly rate will be payable for LA deferred payment schemes.
- Find out more

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Please state your income after income tax or any other relevant tax.
Choose income regularity
Details about your Weekly Income
State retirement pension
Minimum income guarantee/pension (Income support)
Employer’s pension
Private annuities
Attendance allowances
Any other allowances
Income from trust funds
Rental income (after deduction of management cost)
Any other income (shares, capital bonds, interests)
Other income
Total
Details about your Monthly Income
State retirement pension*
Minimum income guarantee/pension (Income support)
Employer’s pension
Private annuities
Attendance allowances
Any other allowances
Income from trust funds
Rental income (after deduction of management cost)
Any other income (shares, capital bonds, interests)
Other income
Total

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Please provide the details of the banks/institutions where these savings are held:
Current bank account balance
Details
Is this a joint account?
Deposit bank account balance
Details
Other deposits (bank)
Details
Bonds
Details
Shares/investments
Details
Any other liquid assets not mentioned above?
Asset type
Amount
Details
Add another?
Asset type
Amount
Details
Total

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Please provide the details for any amounts owed to other parties (not covered in section 8) that will not be settled within the next 30 days. If relevant, this should include any debts subject to a legal judgement or where you have taken responsibility for the debts of any other person. If yes, please state below: Amount:

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*I understand that the above may change in future as my circumstance changes.*
- 1 – I agree to pay the full care fees to RMBI Care Co. with my weekly/monthly income and liquid capital. I will speak to the Home Manager if my capital reaches the statutory threshold limit, where I may be entitled to support from the Local Authority (LA) for future payments of my care fees. I agree to speak to the Home Manager before submitting an application to the relevant authority for financial support.
- 2 – I agree to sell my property and enter into RMBI Care Co.’s deferred payment scheme to fund my care fees. When the sale of my property is complete, I understand that option 1 will be applicable.
- 3 – My care is being funded by the LA on a 12 week property disregard. I agree to pay the difference between the gross LA weekly rate payable for this period of time and RMBI Care Co.’s full weekly rate once the sale of my property is complete. From week 13, if my property is not sold, I agree to apply for a deferred payment scheme with RMBI Care Co. or the LA (option 2 or 4). When the sale of my property is complete, I understand that option 1 will be applicable.
- 4 – My care is being fully funded by the LA on a deferred payment scheme where RMBI Care Co.’s full fees are payable. When the sale of my property is complete, I understand that option 1 will be applicable.
- 5 – My care is being fully funded by the LA.
- 6 – My care is being funded by the NHS.
The information on this form is correct and complete to the best of my knowledge. If applying for a respite stay I declare that I will vacate the accommodation on the date stated. If my respite stay exceeds the stated dates, I will undertake to sign an extension to the respite stay paying in advance or a contract as a permanent resident which will require all sections of this application to be completed. I hereby undertake to inform RMBI Care Co. promptly if any information changes.
Signature*
Full name*
First
Date*

Day
Month
Year
Address*
Street Address City ZIP / Postal Code
The witness must be independent and not a family member.
Full name*
First
Signature*
Date*

Day
Month
Year
Address*
Street Address City ZIP / Postal Code

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Consent*
At RMBI Care Co., we are committed to respecting and protecting your privacy. We will only use your personal information to send you information relating to RMBI Care Co. that you have requested to receive from us. Your details will be stored by RMBI Care Co. and we will continue to request consent on a regular basis. You can withdraw consent at any time by sending an email to enquiries@rmbi.org.uk or by writing to RMBI Care Co., 60 Great Queen Street, London WC2B 5AZ.
We will not share your information with any third parties or store your details outside of the European Economic Area. The information you provide will be held securely by us whether the information is in electronic or physical format and we will only use your data to send you news relating to RMBI Care Co. unless you have consented otherwise.
I agree to the privacy policy.