I consent for Citizens Advice to record and use my personal information? *We may not be able to help if you answer no* *

It is mandatory for you to answer this question, If you select “No” we may not be able to advise you fully

I give my explicit consent for Citizens Advice to record and use my special category data. Yes, I consent to you holding special category data information on my (please tick all of those you agree to)

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Do you consider yourself to be a disabled person or do you have a long-term physical or mental health condition? Put select the relevant option.

Do you have particular communication or information needs as a result of a disability?

If yes, what can we do to help when communicating?

Ethnicity

Religion

Trade Union Membership

Sexual orientation

I consent for Citizens Advice to share information for collecting feedback?

I CAN visit a local Citizens Advice office if needed

Title *

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Name *

First Name Last Name

Address

Street Address

Street Address Line 2

City County

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Email *

example@example.com

Date of Birth *

Day Month Year

Mobile

Area Code Phone Number

Home landline

Area Code Phone Number

We would like to advise you by email as you have contacted us this way but please tick below as applicable so we can be sure of this and let us know which other ways we can get in touch with you if we need to.* *

Email: I am happy for advice to be sent by email Mobile: I am happy to be called, but not happy for a voicemail Mobile: I am happy to be called, I am also happy for a voicemail to be left Home: I am happy to be called, but not happy for a voicemail Letter: I am happy for correspondence to be sent to the address I have supplied

Please select the option(s) below that best describe what your enquiry is about *

Please note we are unable to issue foodbank vouchers via Email advice, please call Adviceline on 0800 144 88 48 *

I understand, I will call Adviceline for my foodbank voucher, but I would like help with other issues which I am including

Please note, once you submit this form, it could 5 working days to get a response (This could be longer during busy period). If you're in crisis and are unable to wait please call Adviceline on 0800 144 88 48 *

Yes, I understand and I can wait 5 working days (Possibly longer)

Marital Status

Household Type

Housing Type

Employment Status

How long have you been employed?

The limitations of our email advice mean we can only provide one response to your query and answering with the details you have supplied, please make sure you supply us with the key information in order for us to respond. This is not a back and forth conversation and therefore we cannot reply to any further emails you send due to our capacity. We may also decide your query is too complex to answer by email and therefore advise you to contact us via another service (Phone or in office).

I understand, I have included all relevant and key information.

Due to the limitations of the email service, we cannot reply to any replies you send to the email advice we send you, this is from a no reply email address.

I understand that I cannot reply to the email advice I receive

Please state what your enquiry relates to

We will use the information you give in your enquiry to provide you with advice and to direct you to the right service. By choosing to include any Special Category Data (including but not limited to information about your health, ethnicity or trade union membership) you are consenting to us using this information for this purpose, even if you did not tick the relevant boxes at the start of this form. For more information about how we use your information, please see our privacy policy

Please provide any further information about specific debts here

Would you like to be contacted by our money advice team? Do you give consent for us to refer you to them?

Yes No

Have you contacted Citizens Advice consumer helpline: 0808 223 1133 ? If so what advice did they give ? (If you haven't contacted them already, we may ask you to do so before we can offer any follow up help.)

Are you currently receiving benefits, if so which benefits?

More details about your enquiry *

Time limits - please provide any key dates we should be aware of. *

We will use the information you give in your enquiry to provide you with advice and to direct you to the right service. By choosing to include any Special Category Data (including but not limited to information about your health, ethnicity or trade union membership) you are consenting to us using this information for this purpose, even if you did not tick the relevant boxes at the start of this form. For more information about how we use your information, please see our privacy policy

Do you have any attachments you would like to include with your submission relating to your enquiry?

Email Advice Form

PLEASE NOTE: We cannot issue foodbank vouchers via email, please call Adviceline on 0800 144 88 48

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