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. 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 optionEmploymentHousingDebtEmploymentPlease 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: 128 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: 128 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: 128 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: 128 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: 128 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: 128 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: 128 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: 128 MB. UntitledUntitledPhoneThis field is for validation purposes and should be left unchanged.