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External Agency Referrals

If you are an external agency, or are referring someone you work with, please complete the below form. Once this form has been submitted, our advisers will contact the client/you within 5 working days.

If the referral is a time sensitive emergency (such as eviction notice) please visit one of our branches.

Privacy Policy(Required)

I Agree that as part of the referral process, Citizens Advice Bury & Bolton (CABB) will ask for some details about myself/the client and the issue they are looking for help with. CABB will use this information to provide me/the client with advice as well as to improve their service and inform their campaigns. More details about rights and how CABB use information can be found on the CABB privacy notice below; www.citizensadvice.org.uk/myinformation www.cabb.org.uk/privacy-policy/

Date Of Referral(Required)

DD slash MM slash YYYY

Referring Organisation Details

Name(Required)

First Last

Organisation(Required)

Address

Street Address City ZIP / Postal Code

Phone(Required)

Email(Required)

Client Consent

Has the client provided consent for this referral to be completed on their behalf?(Required)

Yes - I confirm the client has provided consent to this referral being completed on their behalf

Has the client provided consent for you (the referring organisation) to be updated on the case?(Required)

Yes - the client has provided consent for the referring organisation to be kept updated on the case

No - the client has not provided consent for the referring organisation to be kept updated on the case

Support Worker Details - if different from Referring Organisaton Details

Name Of Support Worker

First Last

Is The Support Worker Attending The Appointment With The Client?

Yes

No

Phone

Email

Client Details

First Name(Required)

Surname(Required)

Date Of Birth (If unknown please put 01/01/1900)(Required)

DD slash MM slash YYYY

Address(Required)

Street Address City ZIP / Postal Code

Client Contact Details

Please fill out as much information as possible so we can contact you.

Mobile Phone Number(Required)

Home Phone Number

Email Address

Communication Preferences(Required)

Phone

Voicemail

Email

Text

Postal Letter

Do Not Contact The Client On(Required)

Phone

Voicemail

Email

Text

Postal Letter

Please note that at least 1 communication method is required to progress this referral.

Support Required

Which Area Does The Client Need Help With?(Required)

Housing

Benefits

Community Care

Debt

Employment

Energy

Family

Immigration

Consumer

Other

Please Explain What They Need Help With(Required)

Please provide as much information as possible so we can route the enquiry through to the correct team.

Contact for Research and Feedback

We want to get feedback on the advice we provide. We will use this information to improve our service and inform our campaigns in a way that doesn’t identify the client. If they want more detail about their rights and how we use their information they can read our privacy notice on our website.

Do Not Contact The Client For Research and Feedback On

Phone

Voicemail

Email

Text

Postal Letter

The client agrees to Citizens Advice selecting them for feedback using their information and contacting them

Δ

Registered Office

1 Victoria Plaza
Oxford Street
Bolton
BL1 1RD

Registered Numbers

Charity Number: 1102536
Company Number: 05030345

VAT Number: 768 279 472

Authorised and regulated by the Financial Conduct Authority (FRN: 617513)

IAA Registration Number: F201400861

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