Advice by Email

Your Contact Details

Email Address *

Title *---MrsMrMissMs

First Name *


Surname *

Address *


   Town *
County *
Post Code *

Home Phone

Mobile

What ways can we contact you to answer your question? *
EmailPhoneMobilePostTextCan leave Mobile VoicemailCan leave message on home phone

About You

Date of Birth

National Insurance Number

Gender *---MaleFemaleUnknownPrefers a different term (other)Prefer not to say

Transgender *---Not applicableFemale to maleMale to femalePrefers a different term (other)Prefer not to say

Ethnic Origin *---White - BritishWhite - IrishWhite - OtherBlack or Black BritishBlack - CaribbeanBlack - AfricanBlack - OtherAsian or Asian BritishAsian - IndianAsian - PakistaniAsian - BangladeshiAsian - OtherChineseMixedMixed - White and Black CaribbeanMixed - White and Black AfricanMixed - White and AsianOtherPrefer not to say

Any disabilities? *---NoneDisabledLong term health conditionPrefer not to say

Your Household

Household Type *---Single PersonSingle person with dependant childrenSingle person with non dependant childrenCoupleCouple with dependant childrenCouple with non dependant childrenPrefer not to sayOther adults onlyOther with dependant childrenPrefer not to say

Housing Type * ---Own OutrightBuying Home (Mortgage etc.)Shared OwnershipCouncil / ALMO TenantHousing Association TenantPrivate TenantHouse through Job / BusinessStaying with Relatives / FriendsHostelPrisonHomeless (incl B&B Tenant)OtherPrefer not to say

Household Monthly Income * ---Less than £400 per month£400 to £599 per month£600 to £799 per month£800 to £999 per month£1000 to £1300 per month£1301 to £1499 per month£1500 to £1999 per month£2000 to £2499 per month£2500 to £2999 per monthMore than £3000 per monthPrefer not to say

Does your partner live at the same address? YesNoNot ApplicablePrefer not to say

Child Dependants Under 14 ---0123456more than 6Prefer not to say

Child Dependants Over 14 ---0123456more than 6Prefer not to say

Number in Household ---12345678more than 8Prefer not to say

Occupation *---Employed more than 30hrs p/wEmployed less than 30hrs p/wUnemployed - seeking paid employmentVolunteerRetiredStudentOn Government scheme for employmentCarer - elderly / disabledCarer - childrenLooks after home - dependantsLooks after home - non dependantsPermanently sick / disabledOtherSelf EmployedPrefer not to say

Sexual Orientation *---BisexualGay ManGay Woman/LesbianHeterosexual/StraightPrefer not to say

Marital Status *---SingleMarriedCohabitingCivil PartnershipSeparated but legally married / CPDivorced / CP DissolvedWidowed / Surviving CP PartnerPrefer not to say

Nationality if not British

Your Problem

What is the nature of the Advice you require? *
---BenefitsCommunity CareConsumerDebtEducationEmploymentFamilyHealthHousingImmigrationOther

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