Warning, Javascript has been disabled, this form will not function correctly.
Forename(s)*
Surname*
Address line 1*
Address line 2
Address line 3
Town*
County*
Postcode*
Mobile Telephone No.
Main Telephone No.*
Email Address
Date of Birth*
Please give details of your enquiry:
Do you need help with any of the following?
What benefits are you and your family currently receiving?
Please tell us any key dates, such as the deadline for completing a claim form or the date of a decision that you wish to challenge:
If bailiffs are attempting to collect on behalf of your creditors, you can find relevant information on the Citizens Advice website or contact the Citizens Advice helpline on 0300 330 1313 (calls to this number costs the same as calling 01 and 02 numbers).
How much are your debts in total?
Council Tax
Rent or mortgage
Gas or electricity
Court fines
Child support
Court Action
Bailiffs visiting
Disconnection of gas or electricity
Deductions from wage or benefits
Please tell us any key dates, such as the date of court hearings:
If you need advice about your employment rights or raising a grievance with your employer, you can contact the free ACAS helpline on 0300 123 1100 (open 8am to 8pm weekdays, 9am to 1pm Saturdays).
Please tell us any key dates, such as the date of future meetings with your employer or the date of your dismissal
If you are contacting us out of normal office hours and need housing advice urgently, you can contact the free Shelter helpline on 0808 800 4444 (open 8am to 8pm weekdays and 8am to 5pm weekends, 365 days a year).
What is your housing issue?
Please tell us any key dates, such as the date of court hearings or eviction:
What type of service is in dispute?
Do you have a disability or long-term health condition?
Please tell us any key dates or deadlines.
Please tell us any key dates or deadlines