Universal Support - self-referral form

This form should be completed for help with managing your money (Universal Support – Budgeting) or making or managing your Universal Credit claim (Universal Support – Digital).

Please provide as much information as possible to help us to ensure you receive the right support.

Privacy Statement
Basingstoke and Deane Borough Council is the data controller for the personal information you provide on this form. You can contact the council by phone on 01256 844844, via email to customer.service@basingstoke.gov.uk or by writing to us at Civic Offices, London Road, Basingstoke RG21 4AH. The council’s Data Protection Officer can be contacted at dpo@basingstoke.gov.uk
The personal information you provide will be used to process your request. It is necessary for you to provide this information to us so that we can process your request/provide the service you have requested.
- We may share your information with other teams within the council in order to provide a service to you, to ensure our records are kept up to date or otherwise where we are required to do so.
- We will not disclose any information to other organisations unless we are required by law to do so or to prevent fraud.
- Your personal details will only be held as long as is needed for this purpose and in accordance with our retention policy.
Please read our full privacy statement for information on how we collect, use and keep your personal information.
Please tick to confirm that you have read the above privacy statement *
Title *
First name *
Last name *
Contact number *
Email *
Confirm Email *
Address 1 *
Address 2
Town *
Postcode *
I would like (please tick):
Universal Support - Budgeting
Universal Support - Digital
Both
Please provide any further information which may help us to help you
To help us avoid abuse of our system, please enter the correct answer to the question below:

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Universal Support - self-referral form

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