Advice in the City Enquiry Form

CONFIDENTIAL QUESTIONNAIRE

Please complete as many sections of this questionnaire as you are able. This will assist in allocating a lawyer and enable us to advise you, maximising the time available in the advice session. If any section is not applicable to you simply mark it N/A.

If unsure how to answer please indicate and the relevant section will be discussed in the Clinic. Fields marked with a * must be completed.

Contact Preferences

At which office would you like your advice session to be held?

Personal Details

Please indicate your current status

Other (please specify)

Name *

Date of Birth *

Address *

Postcode

Email Address *

Telephone

If you would rather we didn't contact you by telephone please leave this box blank.

Occupation *

Your Partner's Details

Name

Date of Birth

Address

Postcode

Occupation

Your Former Partner's Details

Name

Date of Birth

Address

Postcode

Occupation

Your Spouse's Details

Name

Date of Birth

Address

Postcode

Occupation

Your Former Spouse's Details

Name

Date of Birth

Address

Postcode

Occupation

Your Children's Details

Please indicate the number of children with whom you have family relationships

Child 1

Name

Date of Birth

Boy/Girl

School

College

Occupation

State mother and father if not you and your partner/spouse

Child 2

Name

Date of Birth

Boy/Girl

School

College

Occupation

State mother and father if not you and your partner/spouse

If you have more than 2 children please supply additional details at the end of the questionnaire

Has a CSA assessment been made in relation to any child?

If yes, please provide details

Details of the disability, if any, of any of the above parties

Your Relationship

When did your relationship start?

When did you start to cohabit?

If separated, when did you separate?

If married, the date and place of marriage

If divorced, the date of the divorce

Why do you wish for advice?

Have you or your partner/spouse attended any counselling?

Is violence or abuse an issue?

Is religion an issue?

Is immigration/domicile/residency in the UK an issue?

Brief Financial Details

Is your home rented or owned?

Other (please specify)

In whose name is it?

Is it mortgaged?

Please state the value, the amount of the mortgage, or any rental

Please list other major assets with a brief description, and estimate of their value and the source of the asset and in whose name they are held

Please indicate the extent of debts and liabilities with a brief description, and who is liable for them

Please provide the total of the approximate net annual incomes of the following:

You

Your Partner

You Spouse

Please provide a summary of the earned income of the following:

You

Your Partner

You Spouse

Please provide a summary of the unearned income of the following:

You

Your Partner

You Spouse

Please give a brief description of how the income is managed

Additional Information

If you have any further information you would like to tell us about please do so here

The Anthony Gold Family & Relationship Advice Clinic runs at these times:

8am
12.00pm - 2.00pm
5pm

At London Bridge the Clinic runs on Tuesdays and Thursdays. At Streatham the Clinic runs on Mondays and Tuesdays.

Please indicate which preferred date and time you would like to attend

All information supplied in this form will be treated in the strictest of confidence and will be used only for the purposes of the Family & Relationship Advice Clinic. Your details will not be shared with any other department within Anthony Gold.

Mandatory: To help us distinguish between forms submitted by individuals and those automatically generated by spam software, please type the word shown here into the box below.

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Contact

Compliance
Accessibility Statement
Site Map

London Bridge
The Counting House
53 Tooley Street
London Bridge City
London SE1 2QN
tel: 020 7940 4000
fax: 020 7378 8025

Shad Thames
60 Queen Elizabeth Street
London SE1 2PZ
tel: 020 7940 4000
fax: 020 7708 3133

Streatham
Lloyds Bank Chambers
186 Streatham High Road
London SW16 1BG
tel: 020 7940 4000
fax: 020 8664 6484

Walworth
169 Walworth Road
London SE17 1RW
tel: 020 7940 4000
fax: 020 7708 3133

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