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
Single
Married / Civil
Partnership
Cohabiting
Separated
Divorced
Widowed
Marital Status
Children in
household
Names & DOB
Landline Tel:
Address
& Postcode
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
Interpreter needed?
Can client read and write?
Y/N
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
£
£
£
£
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
£
£
Mobile Phone
Contract? Y / N
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?
Have you enclosed signed form of authority?
Have you enclosed proof of client income?
Have you enclosed any of the client’s debt letters
Which other professionals are involved with the client (if any)?
Y/N
Y/N
Y/N
Y/N
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: moneymatters@newcastle.gov.uk
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: moneymatters@newcastle.gov.uk
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
 Recent payslips 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 in your 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: moneymatters@newcastle.gov.uk
Website: http://www.newcastle.gov.uk/benefitsand-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.