1Start2About Your Client3About You Make a Referral If you support a person who may benefit from our services, you can use this form to share their details with us. Only complete this form if: You work in a professional capacity to support people in vulnerable circumstances - for example, through a charity or social work. Your client lives or works in Southwark, Lambeth, Westminster or Camden, or is otherwise eligible to join our credit union.The address displayed in your address bar begins with 'creditunion.co.uk' and a padlock icon is visible. About Your ClientPlease provide some information about the person you are referring to us.Their Name* First Last Which of our services is your client interested in? Bank account Borrowing Savings Other Support What is their preferred method of contact?* Phone Call Email They will visit a branch Client's Phone Number*Email Address* Which Branch Do They Plan to Visit?* Peckham (SE15 ETH) (Mon, Tues, Fri, 9:30am-4:30pm) Walworth Rd (SE17 1RW) (Mon-Fri, 9:30am-4:30pm) Unsure Which of the following forms of identity is your client able to provide?*By law, we need some form of ID in order to open an account for your client. Please let us know below if your client is unable to provide any of the following. Passport Biometric Resident Permit (BRP) Driving License Birth Certificate I will provide a letter What best describes your client's current housing situation?* Permanent Address Temporary Address No Fixed Address My organisation can provide an address for correspondence Do you have any legal authority to act on behalf of this client?You don't need to have a legal relationship with the client to make a referral. However, it may help us to provide more appropriate support. Power of Attorney Court-Appointed Deputy (under the Court of Protection) Appointed Legal Representative Other (please specify below) Any other details which will enable us to better support your clientHas this person given their consent for their details to be shared with London Mutual Credit Union?* Yes No About YouPlease tell us a little bit about yourself, the person making the referral.Your Name* First Last What best describes your role?*Social WorkerHealth Care ProfessionalTeacher/EducatorEmployment AdvisorHousing OfficerBenefits AdvisorCharity WorkerCommunity Support WorkerLegal AdvisorOther (please specify)Please provide more details*What organisation do you represent?*Your email address* Your phone number*Who should we follow up with about this enquiry?* Follow up with me Follow up with my client directly Community & Partners Newsletter Yes, I'd like to receive occasional email updates from London Mutual about its services that are relevant to those in financially vulnerable circumstances in our community.NameThis field is for validation purposes and should be left unchanged.