Vulnerability Support

Vulnerability Self Declaration Form

We know that being in debt can be very stressful, especially if you or someone in your home is going through a difficult time. If you’re struggling, please tell us as soon as you can. Our Welfare Support Team is here to help, we will look at your situation to see what support we can offer or what extra support is available to you.

To help us understand what you need, please fill in this form with as much detail as possible. Once we receive it, a member of the team will look at what you’ve told us and get in touch. You’re not alone, we’re here to help.

First name (s)

Please enter your first name

Last name

Please enter your last name

Marston case reference

Contact Information

Email address

Please enter a valid email address

Validate Email address

Please enter a valid email address

Preferred telephone number

Address line 1

Address line 2 (Optional)

City

Postcode

How would you prefer us to contact you?

Would you like a call back?(Please allow 72 hours)

Vulnerability Context

Do you have any accessibility or communication needs?

Please detail below

Is a debt advice or support organisation helping you?

Please detail below

Please tell us about any medical or personal circumstances that mean you or your household require extra help.

Please upload photocopies of the medical documents/benefit information that confirms what you have told us.(Optional)

Click to upload or drag and drop

PDF, PNG, JPG, JPEG, HEIC, HEIF, DOC or DOCX (Please ensure you upload no more than 5 files, with a combined size not exceeding 15 MB)

Do you want to send an I&E form with your Self-referral?

If yes,please fill the Income & Expenditure form

Based on my current situation, I can afford to pay:

Frequency

By ticking 'Yes', I give my explicit consent for Marston to use the personal data provided on this form solely for the purpose of understanding and appropriately supporting my individual circumstances, in line with their legal and statutory obligations. I understand that Marston will retain this data only for as long as necessary to fulfil these purposes, after which it will be securely deleted.

Contact Information

Vulnerability Context

Thanks for submitting!