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Please complete and submit the form below. This information will be treated as confidential.
Your name
Telephone
E-mail
Job title
Organisation
Street
Street 2
Town/City
County
Postcode
1. Do you advise on social security benefits? Please select one Yes No
2. Have you ever represented a client at an appeal tribunal? Please select one Yes No
3. If you have represented clients which benefits were claimed?
income support. incapacity benefit. disability living allowance. attendance allowance. Other (please tell us which).
4. Please list any training you have had in appeals representation.
5. Are you a volunteer or a paid worker? Please select one Volunteer Paid worker
6. Describe your knowledge of social security benefits? Please select one No knowledge Basic knowledge Good working knowledge Advanced/specialist knowledge
7. Does your organisation provide representation at appeals? Please select one Yes No
8. Does your organisation keep case records/statistical data on clients? Please select one Yes No
9. Can we contact you? Please select one Yes No
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