Housing Application Form – Suffolk Law Centre Forms

Name *

First Name

Family Name

Date of Birth *//

National Insurance Number

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Main Telephone Number *

Leave message on main telephone number?

I'm happy for you to leave a message on my main telephone number

Secondary Telephone Number

Leave message on secondary telephone number?

I'm happy for you to leave a message on my secondary telephone number

Email

What is your preferred contact method? *

Is an interpreter needed? *

Language *

Where did you hear about the Suffolk Law Centre? *

Other: *

Is there any special assistance you may require?

For example, "I am partially deaf and need you to speak clearly"

Enquiry *

Please explain in a few words why you need to see a lawyer/advisor. Please note that we will not be able to give you an appointment unless we have this information.

Name of the person/organisation you are in dispute with/opposition *

Address of the person/organisation you are in dispute with/opposition *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

It is important that we have these details for professional conduct reasons, please note that it is kept confidential.

Housing Enquiry

Please note that as a not for profit organisation we do not provide advice to landlords. We suggest that you search for a suitable solicitor via https://solicitors.lawsociety.org.uk/?Pro=True

Is this matter related to repossession? *

What is the name of your landlord/mortgage provider? *

What is the reason they are seeking possession? *

Are there any court hearings dates or court deadlines? *

Does the property need any repairs? *

Do you receive any benefits? *

Is the matter related to homelessness? *

Have you applied to a council as homeless? *

What is the name of the council? *

Have you received a decision from the council? *

What is the date of any decision you have received? *//

Do you receive any benefits? *

Is the matter related to disrepair? *

Do you have a private or social landlord? *

Have you reported the disrepair to your landlord? *

What, if any, action has the landlord taken to resolve the disrepair issue? *

Are there any rent arrears? *

Has your landlord served notice to quit? *

Is the matter related to illegal eviction/harassment? *

Do you have a private or social landlord? *

Are you still living in the property affected? *

If the matter is related to harassment, please give details of the harassment:

Equality Monitoring Form (for grant funded non-legal aid matters - LAC)

We collect and monitor data on equality to ensure that our policies, practices and procedures promote equality of opportunity. It is also a requirement of our funding grants.

All information provided will be kept confidentially in accordance with the General Data Protection Regulation (GDPR). We hold the individual’s information on our Case Management System, but then anonymise the data for reporting purposes.

Please choose your local authority

Other local authority: *

Sex *

Is your current gender presentation the same as the one observed at birth? *

How would you describe your sexuality? *

Personal status *

What age group do you belong to? *

Do you consider yourself to have a disability? *

Under the Equality Act 2010 a disability is defined as a ‘physical or mental impairment which has, or had a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities’.

Please identify your disability *

Other disability *

Please indicate which ethnic group you belong to *

Other ethnic group *

Country of Birth

Please indicate which religion you consider yourself to belong to *

Other religion *

Are you? *

What is your average monthly income (£) *

Are you in receipt of any benefits? *

Data Protection Statement

The information in this Equality Monitoring Form is important to us because it allows us to monitor our compliance with the law and to ensure that our services are reaching a diverse group of service users. We are also asked, from time to time, to report it, in a anonymised form, to our funders. Any information you provide will be treated with confidence and kept confidential. Because of the nature of this information, we need your consent before we can collect and use it.

You have the right to be told what data we hold about you (though you are likely to have provided us with that data) and to have it corrected if it is wrong. You may have other rights under the data protection legislation and you can out more about these rights from the Information Commissioner’s Office at www.ico.org.uk. For details of our full Privacy Notice, please visit http://www.iscre.org.uk/legal-services/privacy-notice/

I consent to you using this information for the purpose of equality and diversity monitoring. I understand that I can withdraw my consent at any time.

Please tick this box to confirm that you agree to us hold this information *

Yes, I agree

Signature

Housing Enquiry

Equality Monitoring Form (for grant funded non-legal aid matters - LAC)

Data Protection Statement

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