Make an Enquiry About Your Issue

This referral form will be sent to our team of advisers who will contact you within 5 working days of the form being submitted.

Please visit one of our branches if you have an emergency (such as an eviction notice) that is time sensitive.

If you are looking to refer a client or someone you work with to our services for support, please select the tab titled external agency referral and complete the form.

Self Referral
External Agency Referral

URL

This field is for validation purposes and should be left unchanged.

Self Referral Form

Please complete all sections of this form.If you are NOT a Bury or Bolton resident, we may be unable to process your referral. Please visit https://www.citizensadvice.org.uk/about-us/contact-us/nearby/ to find your nearest local office.

I Agree that as part of the referral process, Citizens Advice Bury & Bolton (CABB) will ask for some details about myself and the issue I am looking for help with. CABB will use this information to provide me 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

Personal Details

First Name(Required)

Surname(Required)

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

DD slash MM slash YYYY

Nationality

Address(Required)

Street Address City ZIP / Postal Code

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

Text

Postal Letter

Please state which communication method you would prefer we contact you

COMMUNICATION METHODS NOT TO BE USED

Please state any communication methods you DO NOT want us to contact you using this box

Support Required

Which Area/s Do You Need Help With? (Please tick the ones relevant to you)(Required)

Housing

Benefits

Community Care

Debt

Employment

Energy

Family

Immigration

Consumer

Other

Please note we may not be able to support you to complete forms, however we can provide guidance and answer any questions you may have

Please Explain What You Need Help With(Required)

Please provide as much information as possible so we can route your enquiry through to the correct team. (500 words max)If you are trying to contact us for a non-advice issue, please visit www.cabb.org.uk/about/ - we will not respond to non-advice queries from this form.

Are you in receipt of universal credit?(Required)

Yes

Energy Efficiency

Please tick this box if you would like our team to contact you about ways which you may be able to make savings to your energy bills and maximise your income

Please let us know if you require any adjustments when you are contacted

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 you. If you want more detail about your rights and how we use your information you can read our privacy notice on our website.

Do Not Contact Me For Research and Feedback On

Phone

Voicemail

Text

Postal Letter

I agree to Citizens Advice selecting me for feedback using my information and contacting me

Demographic Data

We want to ensure that we meet the aims and commitments set out in our EDI policy. This includes not discriminating under the Equality Act 2010. Completing the below questions helps us understand the diversity of our organisation and clients.

Gender

Woman (same as birth)

Woman (transgender)

Man (same as birth)

Man (transgender)

Non-binary

Ethnicity

Sexual Orientation

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

Phone

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

PLEASE NOTE THAT IF THE CLIENT IS NOT A BURY OR BOLTON RESIDENT WE MAY NOT ABLE TO PROGRESS THE REFERRAL (EXCLUDING HOUSING ISSUES). PLEASE VISIT OUR GET HELP PAGE TO FIND OUT OTHER WAYS TO ACCESS ADVICE.

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

Text

Postal Letter

Communication Methods Not To Be Used

Please state any communication methods you DO NOT want us to contact you on using this box

Support Required

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

Housing

Benefits

Community Care

Debt

Employment

Energy

Family

Immigration

Other

PLEASE NOTE WE ARE CURRENTLY UNABLE TO PROVIDE ADVICE ON CONSUMER ISSUES. IF THE ISSUE IS RELATING TO A CONSUMER ISSUE, PLEASE CALL THE CONSUMER HELPLINE ON 0808 223 1133 OR VISIT https://www.citizensadvice.org.uk/consumer/

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.

Is The Client In Receipt of Universal Credit?(Required)

Yes

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

Text

Postal Letter

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