Financial Support Line Casework Referral form

Please complete the form below

This form is for use by case/support workers. Your client may be eligible for the Financial Support Line Casework Service if they: have debts and require debt advice and have experienced or are experiencing domestic or economic abuse.

FSL Casework Referral Form

Client's details

Safe to leave messages?
Should we withhold our number?
Is it safe to send a text?
This is for conflict-of-interest purposes only and not requirement to submit the referral form.
Please include any risk issues, for instance still living with perpetrator. If a risk assessment has been completed, please upload a copy at the end of this form.

Referrer’s details

Explicit consent

Reason for referral

Please indicate if the client owes debts to any of these named creditors. If the creditor is not listed here, please specify in the section below and include details of any debt.

Maximum file size: 516MB

Find out more about how to make a referral

Learn more