Help


	SouthWest Disability and

Welfare Rights


	Registered Charity Number 1060309

This Form is to be filled in if you require Help or Advice from the Charity:

If there is anything that we can do to help in any way continue down this page and fill in the Help Form at the Bottom of the page. We can only deal with people in England at the moment and more specifically in the South West Area. We will not refuse to help anyone in England or Wales but that help may consist of an Agency in your own area which could help you better being nearer to you.

Please fill in all fields in this Form.

Everything you send will remain Strictly Confidential and will not be shown or others allowed to read it.

Only the Advisor sees any Request for Advice.

Only the Trustees see any Request for Help.


	Surname:

	First Name(s):

	National Insurance Number:

	Address: (please include postcode)

	Telephone Number:

		Date Of Birth:

	Nature of Request:


	Please explain how we can help you with the above request.


	Send.


	Please Select One


	Clear and Redo


	Remember that all the information requested will be looked at the same day and a reply sent by e-mail within 24hrs of receipt. Please tell us if you require a phone call and if so make certain that you have filled in the part asking for your telephone number.


	All information submitted on this and any other form will not be passed to any other individual or organisation , unless we get your express permission IN WRITING, and only when necessary. Should you decide that you would like us to represent you in pursuing any claims, then the appropriate documentation will have to be completed.


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		Copyright © 1998 SDAWR All Rights Reserved.