IMPORTANT INFORMATION

By using this form you agree to the Citizens Advice service keeping your details on file.

You should only use this form if you live in the vicinity of Ash, Surrey and the immediate surrounding areas. If you live outside of this area, please use the form attached to the Citizens Advice website local to where you live.

I understand this form is only for people in the Ash, Surrey and the immediate surrounding areas.

We aim to respond to your enquiry within 1-3 working days but cannot guarantee this and suggest that if your enquiry is URGENT then you should telephone us.

We will normally respond to the email address you provide on the form and cannot be responsible if any person other than yourself has access to that email account.

Although we aim to provide appropriate advice in our first response, on some occasions we may ask you to telephone us so we can collect further information before providing any advice.

Advice Enquiry Form

Your Name *

Your Address - House Number/Street Name *

District

Town *

Post Code *

Telephone Number

Email Address

Enter Email

Confirm Email Address

Confirm Email

Date of Birth *

What is your enquiry about * Debt Employment Housing Benefits Consumer Other What is your enquiry about

Details of your enquiry *

Please give as much information as possible including relevant dates etc

May we phone you to ask for more info *

Yes

No

Client permission and consent form

When we record and use your personal information we:

• only access it when we have a good reason
• only share what is necessary and relevant
• don’t sell it to commercial organisations

We need to record information about you to help with your enquiry. We have a legitimate interest to do this. Please let us know if you’d like more information about how we’ll use your data.

I prefer to be contacted by *

Email

Mobile

Home telephone

Work telephone

(please tick all those that apply)

By ticking the boxes below you consent to Citizens Advice recording the special category personal data you choose to provide Citizens Advice.

Yes, I consent to you holding information on my *

Ethnicity

Health Condition

Religion

Sexual orientation

(please tick all of those you agree to)