Please use this form if our financial support phone line is busy or unavailable. If your query is not about financial support please visit our Help Centre. MinMaxErrorMessage You must tell us your first name RegExpToMatchErrorMessage MinMaxErrorMessage You have to give us your surname RegExpToMatchErrorMessage Date of birth Day Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 MinMaxErrorMessage You have to give us your date of birth RegExpToMatchErrorMessage MinMaxErrorMessage Please provide a valid email address You must provide a valid email address so that we can contact you MinMaxErrorMessage Please confirm your email address This must be a valid email address This doesn't match the email address you entered MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage LengthErrorMessage MinMaxErrorMessage You have to give us your postcode RegExpToMatchErrorMessage LengthErrorMessage MinMaxErrorMessage You have to give us the last 4 digits of your account number RegExpToMatchErrorMessage I can't make a payment because... I can't make a payment because... I've been affected by coronavirus I've had a loss or reduction in earnings (not related to coronavirus) Other MinMaxErrorMessage This must be completed RegExpToMatchErrorMessage LengthErrorMessage MinMaxErrorMessage This must be completed RegExpToMatchErrorMessage How long do you think you will need payment support for? How long do you think you will need payment support for? Less than 30 days More than 30 days but less than 3 months More than 3 months MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Have you already missed a payment on your account? Have you already missed a payment on your account? Yes No MinMaxErrorMessage This must be completed RegExpToMatchErrorMessage Is it likely you'll miss your next Direct Debit or a future payment? Is it likely you'll miss your next Direct Debit or a future payment? Yes No Not applicable MinMaxErrorMessage This must be completed RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Have you already had a payment break with us? Yes, I've had a payment break for 3 monthsYes, I've had a payment break for 6 monthsNo, I haven't had a payment break yet MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage We need to ask you some further information about your current circumstances This part of the form asks you for information about your current income and expenditure. If you've completed a similar form with another creditor in the last 30 days, you can attach a copy of that form instead. Are you able to send us a completed form from another creditor? YesNo MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Please send your completed form to financialsupport@ikano.net MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Your financial circumstances This part of the form will take around 10 minutes to complete. Please tell us in more detail about your current financial circumstances MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Housing ownership Housing ownership Owner (no mortgage) Owner (mortgaged) Living with parents Tenant (private) Tenant (social) Other MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Employment status (You) Employment status (You) Full Time Part time Unemployed Not working due to illness or disability Self-employed Retired Other MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Employment status (Partner) Employment status (Partner) Full time Part time Unemployed Not working due to illness or disability Self-employed Retired Other MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Monthly Household Income Please tell us about your monthly household income MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Total for household - for example, self-employment £ MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage £ MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (including JobSeekers Allowance, Income Support, Child Benefits, Disability Allowances, Maternity Pay, Statutory Sick Pay) MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Your Monthly Outgoings Please tell us about your essential monthly outgoings MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (gas, electricity, other household fuels (coal, oil), water) £ MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage HP / conditional sale £ MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Please provide more information here MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Please tell us about your other monthly outgoings MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (including food shopping, clothes, toiletries, baby items including nappies, laundry and dry cleaning, alcohol, smoking products, hairdressing) MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (public transport, car including hire purchase or conditional sale vehicle, fuel) £ MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (MOT, servicing, road tax, breakdown cover, parking charges £) MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (including home, car, medical, life) £ MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage (courses, union fees, professional fees £) MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Please provide more information here LengthErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Other Creditors Please tell us about your other Creditors (companies or people you owe money to) MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Contact Details If we need to call you back to discuss your current circumstances, please provide the most suitable number and time to call you: MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Note: Whilst we always will do our best to try and call you back at your preferred time, we cannot guarantee this. MinMaxErrorMessage This is a mandatory field. RegExpToMatchErrorMessage Send