Please fill in the form below to provide us with information to allow us to respond to your enquiry more quickly and accurately.
Full Name (required)
Gender (required) MaleFemale
Disability (required) Not disabledDisabledPrefer not to say
House number/name (required)
Have you used Citizens Advice Rural Cambs before? (required) YesNo
To comply with the Data Protection Act (1998) we must ask for your permission before we record, store, share and process your data. These details may include personal and sensitive information.
Therefore we would be grateful if you could read and tick the permissions you are happy to provide to us to allow us to improve, monitor and evaluate our services
I give my consent to the Citizens Advice service to store, process and record my personal information (required) YesNo
I give my consent to the Citizens Advice service to share my personal information with a trusted organisation for satisfaction monitoring (required) YesNo
I give my consent to the Citizens Advice holding information on my Ethnicity (required) YesNo
Ethnicity (required) ---White: EnglishWhite: ScottishWhite: WelshWhite: Northern IrishWhite: IrishWhite: Gypsy Or Irish TravellerWhite: OtherMixed: White & Black CaribbeanMixed: White & Black AfricanMixed: White & AsianMixed: OtherAsian Or Asian British: BangladeshiAsian Or Asian British: ChineseAsian Or Asian British: IndianAsian Or Asian British: PakistaniAsian Or Asian British: OtherBlack Or Black British: AfricanBlack Or Black British: CaribbeanBlack Or Black British: OtherOther: ArabOther: Any OtherPrefer Not To Say/Unknown
I give my consent to the Citizens Advice holding information on my Health Condition (required) YesNo
(required) Please select...Benefits and Tax CreditsConsumerDebtEmploymentEnding a RelationshipFinancial SkillsHousingImmigrationOther Problems
What benefits are you or a member of your household already claiming? (required)
What is the problem with your benefits? (required)
Circumstance (i.e. reasons for being on/claiming benefit – not working, low income, disability, children, housing, etc.) (required)
What are the goods or services and what is wrong with them? (required)
When did you first find the goods or work was faulty? (required)
Where and when did you buy the goods/services? (required)
How were the goods paid for & do you have a receipt/credit agreement? (required)
Roughly how much money do you owe? (required)
Do you have any rent/mortgage arrears/council tax/outstanding fuel bills? (required)
Are the debts in your name/joint names? (required)
Any savings or assets (e.g. Car valued over £1000)? (required)
How much can you afford to pay each week? (required)
Do you have a current bank account? (required) YesNo
Employed? (required) YesNo
Self-employed? (required) YesNo
Are you a member of a trade union? (required) YesNo
Are you still working? (required) YesNo
If not, were you dismissed, made redundant, walked out, suspended?
How long have you been employed? (required)
Name of employer? (required)
Do you have a written contract? (required) YesNo
What has happened? (required)
Are you: (required) MarriedIn a civil partnershipLiving together
How long have you been married, in a civil partnership, living together? (required)
What is your housing status: (required) RentMortgageJoint namesIn one name
Are there any emergencies, e.g. domestic violence, have nowhere to stay? (required) Please select...YesNo
Present situation, e.g. are you still living together? (required)
Are there any children involved? (required) YesNo
If so, what are their ages?
Are you struggling with any household bills? (required) YesNo
Do you have a bank/Post Office account? (required) YesNo
Are you happy/confident searching for best deals i.e. energy/phones/insurance? (required) YesNo
Do you have any money issues preventing you from buying household essentials i.e. Food/energy/white goods? (required) YesNo
Are you confident with household budgeting? (required) YesNo
Are you homeless, threatened with eviction or have to leave your home for another reason (e.g. domestic violence)? (required) YesNo
Is there an emergency, e.g. court dates, eviction notices, court warrants, threat of violence from somebody? (required) YesNo
If you have a tenancy:
Is it fixed term? YesNo
How long is the term?
Who is your landlord?
Do they live in the same property? (required) YesNo
Do you have any dependent children living with you? (required) YesNo
Are you receiving it? (required) YesNo
Have you applied for it? (required) YesNo
What is the problem with your housing? (required)
Is the enquiry about: (required) YouYour partnerOther person
What is nationality of you/partner/other person? (required)
Full details of immigration enquiry: (required)
Can you briefly describe what you want help with? (required)
What do you want from the Citizens Advice Service? (required)
There is legal protection for people who have been discriminated against on the grounds of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, and sexual orientation.
Do you think this could apply to your situation? (required) YesNo
Please leave this field empty.
Please note that we aim to respond within 3 working days.