Newcastle Welfare Rights Service

Money Matters

Referral form for debt advice

Please confirm: Is there any information known to you that indicates a risk to our staff if we make a visit to this person at their home address?

No Signed ……………………………………………………………..

Yes Please provide more details at the end of the referral form in
‘Additional Information’ box
YOUR CONTACT DETAILS / REFERRED BY:
Name /Organisation
Address
Telephone / Email
CLIENT DETAILS

Client’s name

/

D.O.B

Partner’s name
/

D.O.B

Nat Ins No: / Client’s / Partner’s
Marital Status / Single / Married / Civil Partnership / Cohabiting
Separated / Divorced / Widowed
Children in household

Names & DOB

Address
& Postcode / Landline Tel:
Can we leave a message? Y / N
Mobile Tel:
Can we leave a message? Y / N

FOR OFFICE USE Care First Number ______Date ______ PTO

Employment Status

/ Is Client / Partner self employed? Y / N
Client / Not Working / Retired / Employed / Hours weekly
Partner / Not Working / Retired / Employed / Hours weekly
Housing Status / If Owner, House Value £
Council / Private Rent / Housing Association
Other / Owner Occupier / Outstanding Mortgage £
Client’s health – please provide information below about any mental or physical illnesses or disabilities
Ethnic Origin / Can client read and write? / Y / N
Interpreter needed? / Y / N / In which language?
INCOME / Weekly / Monthly
Wages / Salary - client / £ / £
Wages / Salary - partner / £ / £
Occupational / Private pension / £ / £
State Retirement Pension / £ / £
Income Support / JSA / ESA / £ / £
Pension Credit - guarantee? / £ / £
Child Benefit / £ / £
Child Tax Credit / £ / £
Working Tax Credit / £ / £
Disability Living Allowance / Attendance Allowance / £ / £
Child Support / Maintenance / £ / £
Non-Dependant Income / £ / £
Other / £ / £
Other / £ / £
TOTAL INCOME / £ / £

PTO

EXPENSES / WEEKLY / MONTHLY
Mortgage / £ / £
Second Mortgage (Secured loan) / £ / £
Rent / £ / £
Council Tax / £ / £
Water Rates / £ / £
Insurance – House & Contents / £ / £
Gas Prepayment meter? Y / N / £ / £
Electricity Prepayment meter? Y / N / £ / £
Food, toiletries and cleaning materials / £ / £
Cigarettes / alcohol / £ / £
Clothing / footwear / £ / £
Mobile Phone Contract? Y / N / £ / £
Travel - Public Transport / £ / £
Travel – Petrol, Insurance, Tax, MOT, Service / £ / £
TV Licence / £ / £
School Meals / £ / £
Child Care Costs / £ / £
Magistrates Court Fines / £ / £
CSA / Maintenance Payments / £ / £
Other / £ / £
Other / £ / £
TOTAL EXPENSES / £ / £
PRIORITY DEBTS - Please state name of creditor where known / BALANCE
Mortgage Arrears / £
Second Mortgage Arrears / £
Rent Arrears / £
Council Tax Arrears / £
Gas Debt ( current supplier) / £
Electricity Debt (current supplier) / £
Magistrates Court Fine Arrears / £
Child Support / Maintenance Arrears / £
Hire Purchase Arrears / £
Social Fund loan if deducted from benefits / DWP / £
Other / £
TOTAL / £


PTO

NON PRIORITY DEBTS Creditor name ( Collector name) / BALANCE
1 / £
2 / £
3 / £
4 / £
5 / £
6 / £
7 / £
8 / £
9 / £
10 / £
TOTAL / £
Any court action pending: Y/ N Please provide details ( date / name of creditor …):
Does client owe money to loan sharks / illegal lenders? / Y / N
Any other information
Checklist / Further relevant information
Have you given the client our ‘About Us’ leaflet? / Y / N
Have you enclosed signed form of authority? / Y / N
Have you enclosed proof of client income? / Y / N
Have you enclosed any of the client’s debt letters / Y / N
Which other professionals are involved with the client (if any)?
Please return this referral form to us by one of the following methods:
Post: Money Matters, Callerton House, 4 Callerton Place, Fenham, Newcastle, NE4 5NQ
Fax: 0191 277 1065
Email:
If you need further advice please contact us on 0191 2771050 Mon-Fri 10am -12pm

PTO

Rachel Baillie

Director of Commissioning
Adult and Culture Services Directorate
Newcastle Welfare Rights Service, Money Matters
Callerton House, 4 Callerton Place, Fenham
Newcastle upon Tyne, NE4 5NQ

Tel: 0191 2771050 Fax: 0191 2771044

Email:
www.newcastle.gov.uk/welfarerights

FORM OF AUTHORITY

Name(s):

Address:

I/We have approached Money Matters, at Newcastle Welfare Rights Service,
for advice and assistance with my/our Welfare Benefits & Rights/Financial
Problems.
I/We hereby authorise Money Matters to act on my/our behalf.
I/We consent to the disclosure of any information, confidential or otherwise,
regarding my/our affairs, which they may require of you, including the
information that Department for Work and Pensions and HM Revenue and
Customs hold about my National Insurance contributions, income tax and
benefit claims.
This request is made within the provisions contained within:
· Sections 30 and 34 of the Data Protection Act 1998
· Section 3 (1)(b) of the Access to Health Records Act 1990
· Regulation 33(1)(a)(ii) of the Social Security and Child Support (Decisions
and Appeals) Regulations 1999
Signature:

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Free debt advice from Money Matters

Who are we?

Money Matters is a specialist debt counselling service and we are funded by Newcastle City Council. We give free and impartial debt advice for residents of Newcastle upon Tyne. Your case will be confidential to the Welfare Rights Service unless any information is given which would affect your entitlement to housing or council tax benefit.

How we can help you?

Everybody’s situation is different but we will help you take control of your debts and try to improve your income. We will agree a budget statement with you and talk to you about your options.

If you are eligible, and depending on your circumstances, we may be able to help you:

·  negotiate affordable repayments with your creditors,

·  apply to write off your debts through bankruptcy or Debt Relief Order

·  deal with court action and to fill out county court forms,

·  challenge debts and miss-sold Payment Protection Insurances (PPIs)

·  and/or refer you to other agencies for further help and support.

We will not tell you what to do and we will not take any action without your permission. If you don’t like our advice you don’t have to continue to use our service.

What information we need from you?

The more we know about your finances, the more we can do to help. You will need to tell us about all of your income, outgoings, assets and tell us about all of your debts. If you do not give us the full information, we may give you wrong advice.

Proof of your income can be any of the following:

·  Recent letters from benefits agencies

·  Recentpayslips or bank statements

·  Self employed can provide recent account statements

Please give us the most recent letter for each of your debts. If you do not have all of your debt letters please contact us and we will tell you what you can do about this.

You need to tell us about your outgoings. Check your bills to see how much you spend on your gas, electric, water, telephone, broadband and other expenses. If you are not sure how much you need weekly or monthly for your food, clothing and other outgoings such as hairdressing, gifts for Christmas, papers and pets, please try to keep a diary of your outgoings as we need to know about your spending habits.

What happens next?

When you are referred to us, one member of our team will look after your case from beginning to end. He or she will write to you asking you to send inyour proof of income and debt letters and to sign a ‘Form of Authority’. This is your permission for us to act on your behalf. We will also try to contact you by telephone.

When you contact us and/or send the information we have asked for we will be in touch with you to arrange a suitable appointment. We can meet you in person at our office or we can talk over the telephone. We can visit your home but only if you cannot attend our office due to ill health or disability.

If we have made attempts to contact you by telephone and in writing and we have had no response from you we will assume that you no longer need our advice. For that reason it is important that you make contact with our service. We can return your calls if you have little credit on your telephone.

Our contact details

Money Matters
Callerton House
4 Callerton Place
Fenham
Newcastle Upon Tyne
NE4 5NQ / Phone: 0191 277 1050
Fax: 0191 277 1065
Email:
Website: http://www.newcastle.gov.uk/benefits-and-council-tax/welfare-rights-and-money-advice

Our ‘first aid’ advice to you

As you cannot afford to pay all of your bills on time you have to understand that some payments are more important than others. In money advice we talk about priority creditors and non-priority creditors.

Priority creditors are more important as they have more powers to enforce the debts and if payments to them are missed this can lead to possession and eviction, utilities disconnection, repossession of essential goods and for some debts even to imprisonment (this happens very rarely). We advise you to prioritise the following obligations: rent, mortgage, council tax, TV Licence, fuel bills, hire purchase, Magistrates' court fines and child support payments and keep to any arrangements for payment of arrears.

Non-priority creditors cannot take the same type of action. We call the following debts non-priority debts: personal loans, bank overdrafts, credit cards, catalogues, water rates for domestic premises, benefit overpayments and social loans and some other debts.

If your bank is charging for an overdraft or taking money to pay for a loan please think about moving your income to another bank account so that your income is safe.

Please do not borrow any more money. This will only make things worse. If you do, then we may refuse to help you any further.