Attendance Allowance Eligibility Request Form

Please use the form below to request a callback from our team if you have received a letter from the Coventry City Council informing you that you may be eligible for Attendance Allowance.

If you are human, leave this field blank.

Your name *

Date of Birth

Your phone number *

Your email address

CCA Data Protection Statement *

In order to help you we need to store information about you. The law says we must get your consent to do this. Everything you tell us will be treated confidentially. The information we hold on you will be used solely for the purposes of enabling us to provide you with an effective service. You have the right to make a formal request in writing for access to personal data we hold on you, and to have it corrected if it is wrong. We will not disclose information about you unless the law permits us to, or we have obtained your consent to do so.

I have read the above paragraph, I agree and give my consent to the Citizens Advice Service.

I have read the Privacy Policy.

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