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NWL Referral Form

This referral will be sent directly to Coalville branch. Refer to a different branch.

Name of referring organisation and department
Name of staff member making this referral
Has the client given verbal consent for their details to be passed to Citizens Advice LeicesterShire to allow us to contact them?
Has the client given verbal consent for Citizens Advice LeicesterShire to discuss their case fully with the referring organisation?
Please use this space to give any further information about the issue, including any action already taken, any deadlines or other relevant information