We collect and handle personal data in accordance with our Privacy Policy (https://www.clearpay.co.uk/en-GB/privacy-policy). We'll use personal data submitted through this form to manage your account or respond to your query. If you agree, check box to continue. [ ] I understand

Please select your Country

Please tell us the reason/s for your change in circumstances

You chose 'other' can you tell is in your own words why your circumstances have changed please

Tell us how long you expect you will help for (choose one from the drop down list)

Definition of priority bills: Mortgage/ Rent Secured loans Hire purchase or logbook loans County Court Judgement (CCJ) Council tax TV license Magistrate court fines Gas and electricity bills Current telephone bills Tax, VAT and National Insurance Child maintenance

How much can you pay us each time?

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