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(3-5 Working Days) £25

Vulnerability Information Form

Congratulations! Your form has been submitted successfully. Thank you for your input. We will review it promptly. If you have questions, please reach out.

(To support the preparation of a Vulnerability Notice)

Full Name

Date of Birth

Full Address including postcode

Telephone

Account / Case Details

Creditor / Enforcement Company / Council:

Account / Reference Number:

Section 1: Health & Wellbeing

Do you have any physical health conditions?

If yes, please describe:

Do you have any mental health conditions?

If yes, please describe:

Are you currently receiving medical treatment or medication?

If yes, please list:

Section 2: Financial & Social Circumstances

Current Employment Status:

Are you in receipt of benefits?

If yes, please specify:

Do you have dependent children?

If yes, please give ages:

Are you a carer for someone else?

If yes, please specify:

Section 3: Vulnerability Grounds

Please tick all that apply

If other please state:

Section 4: Supporting Evidence

Do you have documents to support your circumstances?