I declare that the information submitted is true and accurate to the best of my knowledge. I understand that submitting this form does not guarantee assistance.

I understand that any assistance provided through The Bella Hospitality Workers Relief Fund is voluntary gift-based community support and does not constitute wages, payroll, salary, overtime pay, vacation pay, gratuities, severance pay, employment income, or any other employment-related entitlement.

I understand that any employer remains solely responsible for all wages, gratuities, statutory entitlements, and other amounts required by law.