This form is to enable us to collect information on your behalf. It will enable us to support you
more effectively in regards to your jointly agreed Support.
In order to enhance the support we can do for you on your behalf there may be times when we
need to gather or pass on information from/to other agencies, for example social services,
doctors or other housing providers. Signing this form will allow such processes to happen
quickly and effectively. This form gives us the authority to gather or pass on relevant
information whilst we are working on your case without the necessity of you being required to
be present. However, you will always be informed of what action we are seeking to take on
your behalf and the exact type of information we will need to request or disclose.
It would, therefore, assist our support of you if you could sign the declaration below as
confirmation of your agreement for us to have your authority to act on your behalf in respect
of your support.