If you are human, leave this field blank.Initial questionnaireInformation *Unless you are seeking advice on Energy or Debt, this form is for email advice only. For urgent matters please call Adviceline on 0800 144 8848.I understandType of Query *EnergyDebtBenefitsConsumerHousingFamilyWorkGeneral EnquiryOtherTitleFirst Name *Last Name *Date of BirthAddress Line 1Postcode *Email Address *Phone *Would you prefer an email or call back?EmailCall backPlease indicate the best time to reach youBetween 9am-12pmBetween 12pm-4pmDo you have difficulties communicating in English?YesNoPlease tell us your first language.BenefitsWould you like a benefits check? *YesNoThis check ensures you receive all the money you're entitled to. Benefits and tax credits are payments from the government to certain people on low incomes, or to meet specific needs. Your result will be emailed to you alongside with more information.What is your housing status?Home ownerTenantDo you have a mortgage agreement?YesNoTotal mortgageStart of mortgageHome Improvement LoanMonthly repaymentsInterest rateChoose one that applies to youPrivate landlordSocial housingRentCouncil Tax LiabilityAre you or your partner currently in receipt of any benefits?YesNoIf yes, please specifyUniversal CreditPIPAttendance AllowanceDisability Living AllowanceESACarers AllowanceNew Style ESANew Style JSAChild BenefitOtherState retirement pension:Occupational pensionChild MaintenanceMiscellaneousAre you employed?YesNoType of ContractGross pay current yearNet pay current year:Hours WorkedGross pay last yearNet pay last yearDo you have childrenYesNoNumber of ChildrenIn employment / earningsNet pay current yearAgesBenefits / incomeNet pay last yearChoose one that applies to you *I have a smart meter and I know how to use itI would like smart meter advice I don't want smart meter advice / informationI would like a smart meter but I'm being refused by my supplierMy location isn't suitable for smart meter installationFurther informationPlease give details of your question *Please upload any important filesHave you any deadlines (threatened action/ reply-by dates)?What have you done so far? *What would you like us to do for you? *Final questionsSpecial Category Data *To record any information about the following, you will need to give explicit consent (please tick any that apply). We will only ask about these categories of data when they relate to your enquiry, or for us to try and improve our service or produce anonymous reports. We will still advise if you do not consent to this, however, if any of this information is important to your enquiry (for example health benefits) then this may limit how much we can assist or how much detail we can go into.EthnicityHealth ConditionsReligionSexual OrientationTrade Union MembershipDon't record any Special Category DataHow would you describe yourself?White BritishWhite IrishWhite OtherOther - ArabMixed white and Black CaribbeanMixed White and AsianMixed OtherAsian or Asian British IndianAsian or Asian British PakistaniAsian or Asian British OtherBlack or Black British CaribbeanBlack or Black British AfricanBlack or Black British OtherI don't want to answerHow would you describe your gender identity?MaleFemaleNon-Binary IdentityTrans-Male to FemaleTrans-Female to MalePrefer not to answerHow did you hear about us? *CAB Data Protection Statement *In order to help you we need to store information about you. The law says we must get your consent to do this. Everything you tell us will be treated confidentially. The information we hold on you will be used solely for the purposes of enabling us to provide you with an effective service. You have the right to make a formal request in writing for access to personal data we hold on you, and to have it corrected if it is wrong. We will not disclose information about you unless the law permits us to, or we have obtained your consent to do so.I have read the above paragraph, I agree and give my consent to the Citizens Advice Service.I have read the Privacy Policy.Captcha *For security verification, please enter any random two digit number. For example: 16Submit
