Request Advice for Yourself

    Please use this form to request advice from Citizens Advice Hull and East Riding
    If you wish to know more about our Data Protection and Privacy policy, please click here

    Are you requesting advice for yourself?YesNo
    If you are requesting advice for somebody else please use our professional form here

    We need your consent to record and use your special category personal data. If you do not consent to us recording special category data and your enquiry relates to this, the advice we give you may be limited and not specific to your circumstances.

    ***If you do not wish for us to store this information for use in both monitoring and in relation to your enquiry, please do not provide it***

    Before continuing, please confirm that you consent to Hull and East Riding Citizens Advice storing your details

    We need your consent to record and use your special category personal data

    Special Category Information
    Pleases provide any special category data that you consent to us holding. If you do not consent to us storing your special category data, please select "Prefer Not to Say"

    Health Conditions
    Trade Union Membership

    Accessing our service

    Do you need an interpreter?YesNo

    The following 2 questions are asking for your special category data. Please ensure you have given us permission to store this in the section above.

    Personal Details

    Do youlive in Hull or East Riding Council Areas?HullEast Riding
    Do you have a registered home address?

    Your GP Surgery

    Are you a serving or former member of the armed forces?

    Armed Forces Details

    Are you...?

    In which service did you serve?

    What is/was your period of service?

    Were you medically discharged?

    Are you in receipt of...?

    Do we have permission to contact you via phone
    Do we have permission to contact you via email
    Do we have permission to contact you via letter

    Main Reason for Referral

    Please tell us the reason you require support. (please select one option only)

    What is your household situation?

    What is your employment status?

    How are you housed?

    Have you been issued with...

    Do you have more or less than £75 spare monthly income, after all of normal expenses were met?

    Do you have any of these priority debts?

    Are you aware of any of the following urgent actions being taken against you?

    Are there any deadlines or key dates?

    Please tell us about your issue. Please provide as much detail as possible in the text box below

    Do any of the below apply to you?

    Do you have any key dates?

    Energy Details


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