Authority to Act Form

Authority to Act Form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Mobile Number

Area CodePhone Number
Email Address*
example@example.com
Signature*

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Client Authorisation*

I authorise Citizens Advice Merton and Lambeth to act on my/our behalf.
Your Adviser's Name*
Concerning the issue of (tick all that apply)*

EmploymentHousingHealth & CareRelationship & FamilyDiscriminationMoney AdviceImmigrationBenefitsConsumerTravel & TransportOther
Citizens Advice Merton and Lambeth is a registered charity (1046018) and a company limited by guarantee (02914384).

Registered office: 7 Crown Parade, Crown Lane, Morden, SM4 5DA.

Advice Quality Standard (AQS) Certified (0000198)

Authorised and regulated by the Financial Conduct Authority (617664)

Authorised by the Office of the Immigration Services Commissioner (OISC) (N201400305)
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