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Money Advice Referral

Please use the form below if you wish to refer an RBH tenant to the free RBH money advice service

Your Name *

Organisation/Department *

Customer Name *

Customer Email Address *

Customer Address *

Customer Phone Number *

Preferred Contact Method *

Phone

Do they currently have access to food? *

Yes

Do they currently have a useable energy supply to your home? *

Yes

Are they struggling to pay your rent or mortgage? *

Yes

Amount Owed

Do they have any debts? *

Yes

Please state other type of debt *

How much do they owe?

Have they recently been contacted by a bailiff? *

Yes

Help with Bailiffs

Do they need help claiming benefit? *

Yes

Please state other type of benefit *

What is the current status of their claim? (Please tick all that apply)

Awaiting Outcome of a new claim

Benefit Suspended

Benefit not in payment

Benefit Stopped

Additional Comments

Consent for storing submitted data *

Yes, I give permission to store and process my data