CONTACT MONEY MATTERS LEICESTER
Full Name
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Title
*
Please Select
Ms
Mrs
Miss
Mr
Other
I Like To Be Called
Phone Number
Please enter a valid phone number.
Do You Use WhatsApp?
*
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Yes
No
Email
example@example.com
Is email in regular use?
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Yes
No
Address
*
Postcode
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DATE OF BIRTH
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/
Day
/
Month
Year
Date
Current housing
Please Select
Rented - private
Rented - social housing
Mortgage - sole
Mortgage - joint
Lodger
Living with parents or relatives
Hostel
No Fixed Abode
Nationality
*
Do you have or are you eligible for a British passport?
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Are you in receipt of disability benefits?
Please Select
Yes
No
If not, have you tried to claim in the past or are you planning to claim?
Please Select
Applied - turned down
Applied - waiting to hear
Applied - waiting for Appeal or Tribunal
Planning to apply
Total Income per month (on average, excluding overtime / bonuses)
*
What debts are urgent?
*
How much do you owe in total (approximately)?
*
When are you generally available for appointments? Please note we don't do evening appointments.
*
Please Select
Weekdays
School hours
Some Weekdays - please ask
Could you be available at very short notice (if there is a late cancellation)?
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Do you feel you need a face to face appointment rather than a WhatsApp video call? We can do this, though most of our appointments are via WhatsApp or phone.
Do we have your permission to store the information you have given to us? This will be stored on paper and electronically and used only for the purpose of internal checking (by Money Matters Leicester authorised volunteers) that we have given correct information. It will not be shared with anyone else.
*
Please Select
Yes
No
How did you hear about Money Matters Leicester?
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Are we advising anyone you know e.g. friend or family member?
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