Welfare Benefit Appeals in London, Devon, Cornwall, Herefordshire & Worcestershire

Name *

First

Last

Email *

Address *

Postcode *

Phone Number

Preferred Contact Method *

Telephone
Email

Please confirm whether or not you are in receipt of the following welfare benefits? *

Universal Credit
Income Related Employment Support Allowance
Pension Credit
None of the above

If you are not in receipt of any of the above welfare benefits, please confirm your annual household income.

How many adults live in your household? *

How many children live in your household? *

Housing Status *

Please note, we are unable to assist leaseholders or owner occupiers with any issues relating to their property.

Advice

Legal Area *

Housing Enquiry Area *

Who is your landlord? *

Other party's name *

First

Last

Other party's date of birth

Other party's address *

Other party's postcode *

Has there been any domestic violence issues within the household or former relationship?

Yes
No

Has there been any police involvement?

Yes
No

If you are employed or self-employed, what is your monthly or annual income?

Please provide the gross amount (i.e. before tax)

What type of benefit matter do you need assistance with? *

Employer's Name *

Which borough is your employer based? *

Job Title *

Are you a member of a trade union? *

Yes
No

*Please note, if you are a member of a trade union, please seek their advice. We are unable to assist trade union members.*

Date employment started *

Wage/Salary *

*Please note, we cannot advise if your income is more than £45,000 per annum.*

Employment Status *

Hours worked *

Date employment terminated (if applicable)

Do you have any insurance? (e.g. household, motor, mobile phone) *

Yes
No

Do you have any deadlines to meet or hearing dates?

What is the reason you are seeking advice? *

Dismissal
Disciplinary
Grievance
Disability/Sickness

Have you appealed a Benefit decision to the Tribunal? *

Do you have the appeal bundle? *

If you have a Tribunal hearing date and time, please enter it here.

Date

Time

Which areas of family law are you seeking advice on? *

Non-Molestation and/or Occupation Orders
Children
Divorce or Dissolution
Other

Brief description of the issue you are seeking advice on *

Name of referral organisation (if applicable)

Monitoring Equalities Data

Gender *

Date of Birth *

What is your ethnicity?

Do you consider yourself to have a disability or health condition?

Consent

I confirm I have read University House Legal Advice Centre's privacy policy and I give consent for them to store my personal details submitted by this form. I am aware that I can withdraw my consent at anytime. *

I agree

Welfare Benefit Appeals

Do you need help with a welfare benefit appeal?

Advice

Monitoring Equalities Data

Consent