Ealing Advice Agency Enquiry form If you are contacting us on behalf of a client. please use the form below to contact us by email. Agency Enquiry Form Enquiry form for use by agencies. CompanyThis field is for validation purposes and should be left unchanged.Referring agency detailsReferring agency name*Referring staff name* First Last Referring agency phone no.*Referring agency email* Client detailsClient Name*Client House number / Street*Client Postcode*Client Date of birth* Day Month Year Client Email* Client Phone*I am contacting you about:*Select your optionHousingDebtEmploymentPlease select an option:Select oneUnfair dismissalDiscriminationSettlement agreementHow many years have you worked?* Less than 2 years More than 2 years Have you been dismissed?* Yes No Date of dismissal* DD slash MM slash YYYY Please state reason given for dismissal*Have you started the grievance procedure?* Yes No Did you appeal against the decision?* Yes No Have you applied to ACAS /ET?* Yes No Download the grievance procedure form here Brief summary of caseAre you claiming constructive dismissal?* Yes No Have you left?* Yes No Date of leaving* DD slash MM slash YYYY Brief summary of caseWhich grounds have you been discriminated on?* Sex Race Disability Religion Other Please give more detail*Legal advice on what to do if your employer asks you to take early retirement Are you complaining of harassment?* Yes No You might find this link useful. Brief summary of caseAre you looking to come to a settlement with your employer?* Yes No Have they agreed to consider it?* Yes No Please upload the letter referring to your employer agreeing to pay the settlement fee. Drop files here or Select files Max. file size: 32 MB. Have they agreed to fund independent legal advice?* Yes No We could help – would you like to book an appointment?* Yes No Click here to book an appointment Here is some information on rights to legal fees and getting independent advice Why do you want them to consider one?*Brief summary of casePlease upload most recent decision letters or court papers Drop files here or Select files Accepted file types: jpeg, gif, pdf, png, Max. file size: 32 MB. HousingPlease select an option:*Rent / possessionHomelessnessHow much do you owe?* Less than 1 week’s rent More than 2 month’s rent More than 3 month’s rent Have you claimed help with rent?* Yes as a part of UC Yes from Housing benefit Yes – refused help No Have you tried to claim extra help from Local Housing Allowance?* Yes No What was the outcome?*Action by your landlord Letter Notice Applied to court Obtained order Obtained a bailiff Date served* MM slash DD slash YYYY Date effective* MM slash DD slash YYYY Court date* MM slash DD slash YYYY Please choose an option: Ajourned Suspended Outright Date served* MM slash DD slash YYYY Brief summary of case*Please upload any recent notices, court orders or decision letters. Drop files here or Select files Accepted file types: jpeg, gif, pdf, png, Max. file size: 32 MB. Are you still in your property?* Yes No Have you applied to the council for help?* Yes No Have they accepted your application?* Yes No What is wrong with your housing?*Date of decision* MM slash DD slash YYYY Have they "discharged" ( cancelled) their duty?* Yes No Date of decision* MM slash DD slash YYYY Brief summary of case*Please upload any recent decision letters you may have.Accepted file types: jpeg, gif, pdf, png, Max. file size: 32 MB. BenefitsDo you want help with applying for benefit? Yes No Have you checked on an on online calculator?* Yes No Have you checked on the government's website? Go to turn2us – it will allow you to work out what you could claim or additional help you can get. Brief summary of your caseDo you want help with challenging a benefit refusal?* Yes No Have you had a decision?* Yes No Please upload the decision letterMax. file size: 32 MB. Date of decision* MM slash DD slash YYYY Have you have asked for a mandatory reconsideration?* Yes No Have you had a decision?* Yes No Date of decision MM slash DD slash YYYY If you disagree with it, have you asked for an appeal?* Yes No Brief summary of your casePlease upload any recent decision letters/notice s you have.Accepted file types: jpeg, gif, pdf, png, Max. file size: 32 MB. DebtDo you have a debt issue?* Yes No Do you agree that you owe the money?* Yes No Do you have more than one debt?*Please check all that apply Rent Council tax Tax / Tax credits Utilities (gas / electricity / water) Credit card Other Please describe*What action has been taken?*Please check all that apply Letters Frozen account Debt collector letters Court actions Threatened court action Started bailiffs Sent letters bailiff enforcement Attachment of earning / benefits Do you need more information on options? Yes No Link for more information. Have you completed an income expediture sheet in the last 3 months? Yes No You can download an income /expenditure sheet here (PDF) Brief summary of casePlease upload : your income details, expenditure details AND a list of who you owe money to. This will help us help you.Accepted file types: jpeg, gif, pdf, png, Max. file size: 32 MB. Please upload any letters demanding money . bailiff's notices. Drop files here or Select files Accepted file types: jpeg, gif, pdf, png, Max. file size: 32 MB. UntitledUntitled