Request for help

Page 1 fieldset

Tell us who you are

Tell us who is filling out this form
Does the person you are referring claim any benefits?

Do you claim any benefits?

Does the person you are referring claim any benefits?

Do you claim any benefits?

This form is only to be used by people who do not claim any means-tested benefits. Please make an application to the Local Social Discretionary Fund instead Get emergency help with food, energy bills and other essentials