Request for Advice We provide advice over email for a variety of issues. Once you fill in our email form, someone from one of our local offices will contact you within 2-3 working days with a response to your enquiry. If you need help applying for Universal Credit, knowing what benefits you are eligible for, or have a problem with Universal Credit before the first payment you should contact the Help to Claim team by phone or webchat here. If the adviser is unable to resolve your query via email, they will pass your details on to your local office who will contact you by phone to arrange an appointment. Please provide sufficient detail of your enquiry in your email. Data Protection At Citizens Advice we must ask you for your consent to record, use, or share personal information. This form is used to do that. We have a legitimate interest to do this. When we record your personal information we will only access it when we have good reason, not sell it to commercial organisations and only share what is necessary and relevant. The information will be used to provide you with advice. To help with your enquiry we may need to record details of your case. We also need to seek consent to record special category data including ethnicity, details of disability and health conditions, religion, sexual orientation and trade union membership. It is not compulsory for you to reveal this information. If you do not wish to tell us any of the special category information you may leave that section of the form blank. If you agree this information will be used to give you advice, help gather data to improve our service and support research through anonymised reporting. You information will be kept safe in our secure case management system and remain confidential unless exceptional circumstances require us to disclose information. This means we will only pass on the information if we believe there is a risk of you or someone else suffering serious harm or a serious crime is planned or has been committed.I consent for Citizens Advice to record and use my personal information? *YesNoIt is mandatory for you to answer this question, If you select “No” we may not be able to advise you fullyI consent for Citizens Advice to record and use my special category data?YesNoIt isn’t mandatory for you to answer this questionI consent for Citizens Advice to share information for collecting feedback?YesNoIt isn’t mandatory for you to answer this questionFull Name *Date of BirthDD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountryInformation about youTitle *Mr.Mrs.Ms.Miss.Dr.Other.GenderMaleFemaleUnknownTransgender – Male To FemaleTransgender – Female To MaleTransgender – Prefer Not To SayTransgender – OtherPrefer a Different Term (Other)Prefer Not To SayNationalityEmail *EmailConfirm EmailTelephone / Mobile Number *Do you give consent to any of the following?You can contact me by emailYou can ring me on my PhoneYou can leave a message on my PhoneYou can send me a LetterTick for Yes or leave blank for NoHave you sought Advice from Citizens Advice before? *YesNoUnsureWhich of the following does your enquiry relate to? *HousingBenefits / Tax Credits / Universal CreditFamily and RelationshipsDebtConsumer Goods / ServicesImmigrationHealthEmploymentDiscriminationLegalOtherDetails of Issue*Please provide the details of your enquiry with as much information as possible. The more we know about your circumstances the more we are able to help. If relevant, please include details of the following: Important dates and deadlines, including the dates of any payments, letters or purchasesAny relevant amounts of money (including income, benefits, savings, inheritance, or other relevant figures)Details of current personal circumstances relevant to your enquiry (such as any caring responsibilities you may have, whether you are in education, your employment status, etc)Details of any documents you have attached File UploadFile UploadFile UploadDo any of the following apply to you? *I DO NOT have regular access to a computer or the internetI DO NOT have regular access to a phoneI am unable to visit a Citizens Advice Office in personNone of the above apply to meThe following is a special category data that may assist in giving comprehensive advice on your enquiry. You do not need to fill in any sections you do not wish too.HealthNoneLong Term DisabledMental Health ConditionPhysical Disability (Not Sensory)Visual ImpairmentHard of HearingDeafLearning DifficultiesCognitive ImpairmentMultiple ImpairmentsOther Disabilities (Type not given)Prefer not to sayEthnic OriginWhite BritishWhite EnglishWhite ScottishWhite WelshWhite Northern IrishWhite IrishWhite Gypsy / Irish TravellerWhite OtherMixed White and Black Caribbean Mixed White and Black AfricanMixed White and AsianMixed OtherAsian or Asian British Bangladeshi Asian or Asian British ChineseAsian or Asian British IndianAsian or Asian British Pakistani Asian or Asian British OtherBlack or Black British AfricanBlack or Black British CaribbeanBlack or Black British OtherOther – ArabOther – Any OtherUnknownPrefer Not To SayMarital StatusSingleMarriedCohabiting Civil PartnershipSeparated by legally Married / in Civil Partnership Divorced / Civil Partnership dissolvedWidowed / Surviving Partner from a Civil PartnershipPrefer Not To SayHousehold TypeSingle PersonSingle Person With Dependant ChildrenSingle Person With Non Dependant ChildrenCoupleCouple With Dependant ChildrenCouple With Non Dependant ChildrenOther Adults OnlyOther With Dependant ChildrenPrefer Not To SayHousingBuying Home (Mortgage, etc)Shared OwnershipCouncil / ALMO TenantHousing Association / RSL Tenant Private TenantHousing Through Job / BusinessStaying With Relatives / Friends (Rent Free)Staying With Relatives / Friends (Paying Rent)HostelPrisonHomeless (Including B&B Tenant)Residential Accommodation (Nursing / Car Home)OtherPrefer Not To SayEmployment StatusEmployed Over 30 Hours Per WeekEmployed For Less Than 16 Hours Per WeekEmployed Between 16 and 29 Hours Per WeekUnemployed Seeking Paid EmploymentVolunteerRetiredStudentOn Government Scheme For EmploymentCarer – Elderly / DisabledCarer – ChildrenLooking After Home – No DependantsLooking After Home – With DependantsPermanently Sick Or Disabled Self EmployedOtherPrefer Not To SaySexual OrientationStraight / HeterosexualGay ManGay Woman / LesbianBisexualPrefer Not To SayReligionNo ReligionChristian (Any denomination)Christian (Catholic)Christian (Protestant)BuddhistHinduJewishMuslimSikhAny Other ReligionPrefer Not To SayFirst LanguageCaptcha * What is 7+4? 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