Debt email advice Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2I understand that my personal information will be stored and used in accordance with Citizens Advice Hull and East Riding’s Data Protection and Privacy Policy *YesIf you do not give us permission for us to store your details we will not be able to accept this referral. Without your permission we cannot store your phone number or email address to contact you to book an appointment or answer any advice queries that you have. Please click here to view the Citizens Advice Hull and East Riding Data Protection and Privacy Policy: https://www.hullandeastridingcab.org.uk/disclaimer-copyright-privacy/ If you do not wish to consent to us storing your details by using this form you can contact us on the telephone for advice or visit one of our offices. Please note that the help and assistance we can give may be limited if you do not consent to your details being recorded if you speak to an advisor on the telephone or visit one of our offices. Our contact details and opening times are here: https://www.hullandeastridingcab.org.uk/contact-us/ Please click here to view the Citizens Advice Hull and East Riding Data Protection and Privacy Policy: https://www.hullandeastridingcab.org.uk/disclaimer-copyright-privacy/ Please confirm that you have read and understood the instruction above.YesFull Name *Date of birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email *EmailConfirm EmailPostcode *Please check your contact details and confirm that they are correctYesWe will now ask some profiling questions. Why do we ask this? Funders will often ask what sort of people are using (or not using) our services. Your information allows us to report which groups of people use our services the most and the least. This can help us when we are submitting bids for funding. We will never release your personal information to any Funder. All information listed in funding bids is in number and percentage terms only Ethnicity *White - English, Welsh, Scottish, Northern Irish or BritishWhite - IrishWhite - Gypsy or Irish TravellerWhite - OtherMixed - White & Black CaribbeanMixed - White & Black AfricanMixed - White & AsianMixed - OtherAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - OtherBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British - OtherOther - ArabOther - Any OtherRomaPrefer Not To SayHealth condition(s) *NoYesUnknownPrefer Not To SayPlease select the relevent long term health issue(s)Addiction - Chronic or long-term conditionAddiction - Chronic or long term painDexterity eg: lifting or carrying objects, using a keyboardHearingLearning, understanding or concentratingMemoryMental healthMobility (moving around)Neurodivergence (including autism, social or behavioural differences or ADHD)Neurological condition (including epilepsy)Physical impairment (non-sensory)Speech or languageStamina or breathing or fatigueVisionNone of these describe my impairment, condition or access needSexual orientation *Bisexual / PansexualGay or LesbianHeterosexual / StraightAsexualPrefer Not To SayTrade union membership *Member Of A Trade UnionNot A Member Of A Trade UnionPrefer Not To SayReligion *No ReligionChristian (Any denomination)Christian - CatholicChristian - ProtestantBuddhistHinduJewishMuslimSikhAny Other ReligionPrefer Not To SayGenderMaleFemaleNon-binary, gender fluid or gender queerOther (Prefer to use a different team)Prefer not to sayPlease select your household type *Single personSingle person with dependant childrenSingle person with non-dependant childrenCoupleCouple with dependant childrenCouple with non-dependant childrenOther adults onlyOther adults with dependant childrenOther adults with non-dependant childrenPrefer not to sayPlease select your housing type *Own outrightBuying home (with mortgage etc)Shared ownershipCouncil / ALMO tenantHousing associationPrivate tenantHoused through jobStaying with relatives/friends (paying rent)Staying with relatives/friends (rent free)HostelPrisonHomeless (inc. b&b tenant),Residential accommodation (care home etc)OtherPrefer not to sayPlease select your employment status *Employed 30 or more hours per week,Employed between 16 and 29 hoursEmployed less than 16 hoursUnemployed – seeking paid employmentVolunteerRetiredSemi-retiredStudentOn Government scheme for employmentCarer for elderly / disabledCarer for childrenLooking after home - No dependentsLooking after home - with dependentsPermanently sick / disabledTemporarily sickSelf employedCasual / seasonal workerOtherPrefer not to sayPlease select your marital status *SingleSeparated but legally married / civil partnershipDivorced / civil partnership dissolvedWidowed / surviving civil partnerMarriedCohabitingCivil partnershipPrefer not to sayDo you have a partner / ex partner who may be receiving debt advice from us? YesNoPlease give name and address of current or ex partner *It would be helpful for us to know more about your query. Please answer the questions below. Do you own any of the following?House (including paying mortgage)Car / Motorbike worth less than £4000Car / Motorbike worth more than £4000Savings of more than £2000Other [explain in free text box]NonePlease explain why you selected 'Other' in the previous question *What are your income sources? (Please tick all that apply)WorkBenefitsPensionOtherNoneWhat is your total monthly household income from the above sources after any deductions?Under £500£501 - £1000£1001 - £1500£1501 - £2000£2000+Do you have less than £75 pm spare income after all of your normal expenses have been met (before paying any debts)? *YesNoDo you have less than £50 000 worth of debt? *YesNoDo you have any of the following debts (tick all that apply)?Current rent or mortgageCurrent Gas supplierCurrent Electric supplierHire PurchaseCouncil taxCourt finesNone of the aboveIs there any current court action, important deadlines or other serious action pending? Please select from the below options *Eviction - I have an eviction notice to leave the property onBailiffs visitingNo money for food or heatingHaving gas, water or electricity disconnectedI have a statutory demand or creditor's petition for bankruptcy and need to respondCourt appearance - I need to attend for a possesion hearingMoney taken directly from bank accountArrestOther - I have a committal warning for non payment of council tax and need to respond byOther – I have another urgent matter (please give details)I do not have an emergencyPlease give any further details about your emergency, including dates if applicable *In the box below tell us, in detail, what your debt situation is. What you write here, is the ONLY information we will use to give you one-off debt advice. *NextPlease confirm that you are ready to submit your responses *SubmitBackSubmit
