Name (Full name)

Email

Details of your debt enquiry (List of debts & amounts)

Phone Number

Date of Birth

Address

Please confirm that you are happy with our Privacy Notice stating that we'll collect and store any personal information you provide, but won't share it. Please confirm that you are happy with our Privacy Notice stating that we'll collect and store any personal information you provide, but won't share it. Yes, I am happy

Before your appointment we will need you to complete our Welcome Pack which consists of consent forms, an income and expenditure sheet and a 'Pre Appointment Information' sheet which lists documents you will need to provide. Please select the way in which you would prefer to return the pack Before your appointment we will need you to complete our Welcome Pack which consists of consent forms, an income and expenditure sheet and a 'Pre Appointment Information' sheet which lists documents you will need to provide. Please select the way in which you would prefer to return the pack via Email via Upload Link so you can send the documents directly to the case file (link lasts 72 hours) via Post

In order to send you the relevant Welcome Pack documents, please let us know if you receive Universal Credit. In order to send you the relevant Welcome Pack documents, please let us know if you receive Universal Credit. Yes No

In order to send you the relevant Welcome Pack documents, please let us know if you have any Health Conditions. (We need your explicit consent to store some information regarding your health conditions. If you agree, we'll use this information, which is known as 'special category personal data' to help progress your case. By ticking the box below, you consent to Citizens Advice Mid Lincolnshire storing the special category personal data that you have provided.) In order to send you the relevant Welcome Pack documents, please let us know if you have any Health Conditions. (We need your explicit consent to store some information regarding your health conditions. If you agree, we'll use this information, which is known as 'special category personal data' to help progress your case. By ticking the box below, you consent to Citizens Advice Mid Lincolnshire storing the special category personal data that you have provided.) Yes No