Get Advice Email Form | Citizens Advice Bournemouth Christchurch & Poole

Please note that we can only handle advice requests from Bournemouth, Christchurch and Poole residents. If you are not a BCP resident, please contact your local office

Your Details

First Name *

Last Name *

Phone Number *

Voicemail Consent

Permission to leave a voicemail if required

Email Address *

Address *

Postcode *

Letter Consent

Permission to send letter if required

Date of birth

Gender

Marital Status

We will use the information you provide 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, religion, sexual orientation or trade union membership) you are consenting to us using this information for this purpose. For more information about how we use your information, please see our Privacy Policy

To help us improve our service and support our research while keeping your identity protected, we’d like to ask you to share some further information. Please note that it is down to your discretion if you wish to share any additional information. If you do not wish to share any information, please ensure you select ‘Prefer Not to Say.’

Ethnicity *

Disability/Health Condition *

Religion *

Sexual Orientation *

Your Enquiry

What is your enquiry about *

Tell us what you need advice about. So we can give you the right advice, tell us: – What you need help with (give as much detail as possible so we can give you the best advice) – If you’ve done anything so far to try to deal with the problem. *

What are you hoping we can do for you? *

There is legal protection if you are treated unfairly because of your race/gender/disability/sexual orientation/religion or belief/age. Do you think this could apply to your situation? *

Any additional comments *

Tell us what you need advice about. So we can give you the right advice, tell us: – What you need help with (give as much detail as possible so we can give you the best advice) – If you’ve done anything so far to try to deal with the problem. *

What benefits are you already claiming? *

What benefits is any carer, person you are caring for, or member of your household getting? *

The rules are different for some people who are not British or who have been living outside the UK. Does this apply to you? *

If issue is Housing Benefit or housing element of Universal Credit, is there an eviction risk? *

Reasons for claiming benefit (not working, low income, disability) *

There is legal protection for people who have been discriminated against on the grounds of race/gender/disability/sexual orientation/religion or belief/age. Do you think this could apply to your situation? *

Are there any important deadlines? *

We need your permission to collect any sensitive personal information you give us – for example, about your health condition, ethnicity or sexuality. You can check how we’ll use this information. Do you give us permission to collect any sensitive personal information you’ve given us? *

Any additional comments *

Tell us what debts you have e.g. council tax or rent arrears. Please give as much detail as possible – this will help us give you the best advice. *

Please tell us if you have any emergencies e.g. bailiffs, repossession, court hearings, eviction, loss of utilities, warrant for arrest? *

Is there an express intention. In writing, to take action against you within the next 48/72 hours or two/three working days? *

Where does your income come from? *

Do you have any insurance policy that may cover any of your payments? *

Are any of your debts business debts? *

Any additional comments *

Are you still working? If not, were you dismissed, made redundant, walked out, suspended? *

How long have you worked for your employer? *

Are you employed or self-employed? *

For the purposes of storing data, Trade Union membership is considered to be Special Category Data, which we require your consent to store (please refer to privacy policy above for more information). Are you happy to share details of your trade union membership? *

Are you a member of a trade union, and if so, would you be able to share details of this? *

The rules are different for some people who are not British nationals – does that apply to you? *

Name of employer *

Does your home come with the job, e.g. bar work, nanny, agricultural tenancy? *

Do you have a written contract? *

There is legal protection if you are treated unfairly because of your race/gender/disability/sexual orientation/religion or belief/age. Do you think this could apply to your situation? *

Any additional comments *

Tell us what you need advice about. So we can give you the right advice, tell us: – What you need help with (give as much detail as possible so we can give you the best advice) – If you’ve done anything so far to try to deal with the problem. *

Are you homeless, threatened with eviction or have to leave your home for another reason (e.g. domestic violence)? *

Are you threatened with eviction within 8 weeks? *

If you have a tenancy, is it fixed term (and how long)? *

Who is your landlord and do they live in the same property? *

Do you have any dependent children living with you? *

The rules are different for some people who are not British nationals – does that apply to you? *

Are you receiving housing benefit or the housing element of Universal credit or have you applied for it? *

There is legal protection if you are treated unfairly because of your race/gender/disability/sexual orientation/religion or belief/age. Do you think this could apply to your situation? *

Any additional comments *

This form can be used by individuals as well as organisations or carers on behalf of clients who require access to a food voucher. If the criteria to receive help from the Food Bank is met, we will email a copy of the voucher to be redeemed directly to the individual who requires it. If the individual is unable to access or print the voucher, please add the email address they would like it sent to. Depending on where the individual lives, some of the food banks will accept a code only referral from us so there would not be a requirement to print. If further information is required in order to issue a food voucher, we will contact you on the mobile number provided. Our Advisers will likely call from a withheld number but we will leave a voicemail and try again later. By completing this request for a Food Voucher form, a record of your details will be made on our private and secure system as well as the Food Banks secure system. If you are completing this form on behalf of another, you have made the individual aware that their data will be securely stored on our system and the Food Banks secure system.

As part of GDPR rules, we require your express consent to share your personal information (including name, address, date of birth, etc.) as well as any relevant special category data (such as any health conditions and ethnicity), with the closest Trussel Trust foodbank in BCP to you, for the purposes of providing you with a foodbank voucher. *

Yes, I consent

What is the reason for the Food Voucher? E.g. Have you recently lost your job? Do you have unmanaged debts? Are you waiting for your benefits to start? *

What benefits are you in receipt of or recently applied for? E.g. Universal Credit *

Are you currently employed? *

Do you currently have any unmanaged debts? If so, please state the creditor and an estimate of how much is owing as well as any enforcement action. *

How many people are in your household and what are their ages? E.g. Three people aged 9, 35 & 37 *

Can you provide ID to receive the food parcel? E.g. bank card or photo ID *

Do you have access to your own cooking facilities? *

How do you normally get your food shopping? *

If other please state how you normally get your food shopping *

If you are unable to attend, do you have someone who could attend on your behalf? E.g. friend, family etc. *

What is your year of birth? (This is a required question from the Food Bank Service) *

Do you require advice on another issue? E.g. Income maximisation, employment, etc. Please let us know the issue in the box below. If you do not require additional help please put N/A *

Please check all of the personal details at the start of the form relate to the person who requires the food voucher. Please ensure all of the above questions are answered fully. Incomplete answers can result in delays in issuing your voucher if we have to obtain further information from you.

Any additional comments *

Is your enquiry regarding abuse against yourself, or someone else? *

What type of incident has occurred? *

Do you feel you are at risk of harm at this present time? *

Is this the first time this has happened or has this happened more than once? *

Where has this incident taken place? *

Are you living in the same household as the perpetrator? *

Have you been in touch with any services so far? *

Please tell us the safest way to contact you

Any additional comments *

What is your nationality? *

How long have you been in the UK? *

Do you have a valid national ID document such as a passport? *

Do you have a spouse, dependant children or relatives? If so, please list their ages and nationalities *

Please provide a brief overview of your immigration history and your current situation *

Any additional comments *

Your Consent

I agree with the privacy policy

Read our privacy policy

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