Banff and Buchan Citizens Advice Bureau

Banff and Buchan Citizens Advice Bureau

Towns House, Broad Street,

Peterhead

AB42 1BY

Tel: 01779 491288

Fax: 01779 478586

E-Mail:

Opening hours: Monday to Friday 10:00 to 14:30

MONEY ADVICE
We require the following to be completed in full, and returned. An appointment with a money advisor will then be arranged. Please ensure you complete all details required. A financial statement will be prepared and all options will be discussed at the meeting. A joint decision will then be made as to how we can proceed.
Depending on the option chosen, further information and documents may be required.
Please ensure all creditor details are included, particularly account numbers and addresses
DATA PROTECTION ACT 1998
In order to help you we need to maintain a record of your case that may contain personal and sensitive data. The law says that we must have your consent to do this. Everything you tell us will be treated confidentially.
For the purpose of the Act the data controller is:
Banff and Buchan Citizens Advice Bureau
I give my consent to Banff and Buchan Citizens Advice Bureau maintaining a record of my case, including any personal, sensitive data.
Name / Signature / Name / Signature
Name / Signature / Name / Signature
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Name: / Partner:
D.O.B. / D.O.B.
N.I. No: / N.I. No:
Marital Status / Single / Married / Separated
Divorced / Widowed / Other
Address Line 1:
Address Line 2:
City/Town:
Postcode:
Telephone: / Mobile:
Email: / @
Previous address (within last 5 years)
Disabilities/Health Issues
Other Household Members Ages
Housing Status / Mortgaged Property / Owner
Rented Accommodation / Other
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Income from Employment

Self / Partner
Wages Amount / £ / Wages Amount / £
Weekly / Monthly / Weekly / Monthly

Income from Benefits / Pensions and Credits

Please tick payment period
Weekly / Fortnightly / 4 Weekly / Monthly
Type of Benefit / Amount / Type of Benefit / Amount
£ / £
£ / £
£ / £
£ / £

Expenditure

***All amounts should be shown as monthly figures***

Mortgage / £ / Rent / £ / Other / £
Loan secured on the property / £
Council Tax / £ / Gas / £ / Electric / £
Other Fuel / £ / Phone / £ / Mobile / £
TV Licence / £ / Home Insurance / £ / Life Insurance / £
Car Costs / £ / Travel Costs / Petrol / £
Food etc. / £ / Clothing / £ / Satellite / £
Internet / £ / Child Costs / £ / Others / £
£ / £ / £
£ / £ / £
£ / £ / £
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Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
/ Page / 1 / of / 6 / 18 August, 2014
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
Name: / Name:
Address: / Address:
A/C No / A/C No
Total Outstanding / £ / Total Outstanding / £
Usual payment / £ / Usual payment / £
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Banff and Buchan Citizens Advice Bureau

Towns House, Broad Street,

Peterhead

AB42 1BY

Tel: 01779 491288

Fax: 01779 478586

E-Mail:

Opening hours: Monday to Friday 10:00 to 14:30

Form Of Authority

Name:
Address Line 1:
Address Line 2:
City/Town:
Postcode:

I/we hereby authorise Banff and Buchan Citizens Advice Bureau to correspond with you on my/our behalf.

Date:
Signature:
Signature:

The CAB operates a policy of allowing clients access to information held about them, however, in exceptional circumstances if the information you provide is to be withheld from the client, then this must be stated clearly.

Registered in Scotland number 109146

Company Limited by guarantee

Registered as a charity by the Inland Revenue

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