Domestic abuse enquiry form- Clare's law

Please note we have had intermittent issues with our online forms since Tuesday 9 January. If you have submitted a form between Tuesday 9 January and Thursday 12 January and do not have a response within 5 days, please contact us again. If you wish to speak to us sooner in a non-emergency please dial 101 and in an emergency dial 999.

Please note this form is not monitored 24/7. Therefore if your enquiry is urgent please phone 999 in an emergency and 101 in a non-emergency situation.

Important information for you to read before completing the form.

Are you in immediate risk? If yes, please dial 999.

If you are not in immediate risk please continue to complete this form.

  • Disclosure will only be given to the person at risk and or person who are in a position to safeguard.
  • 24 hour timescale for checks to eliminate immediate risk.
  • Face-to-face meeting follows within 10 days.
  • Proof of ID will be required.
  • The enquiry will be completed within 35 days.

 

  1. Please note the term subject is used during this form. Subject refers to the person who you are making the enquiry about
  2. Who are you concerned about?(*)
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  3. What has prompted you to register an interest in the subject(*)
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  4. Additional comments on why you have registered an interest
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  5. Does the subject know you are making this enquiry(*)
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  6. Are you concerned about the subject knowing that you are making this enquiry(*)
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  7. Does the person at risk know that you are making this enquiry(*)
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  8. Have you reported a domestic incident to the police in the past 12 months(*)
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  9. Please provide a brief overview of incident
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  10. Your details

  11. Full Name:(*)
    Please let us know your full name.
  12. Tel:(*)
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  13. Your Email:(*)
    Please let us know your email address.
  14. Address:(*)
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  15. Postcode:(*)
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  16. Preferred method of contact:(*)


    Please select your preferred option
  17. What is the best time to contact you?(*)
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  18. Relationship to the subject:(*)
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  19. Details of person you are concerned about

  20. Full Name:(*)
    Please let us know your full name.
  21. Tel:(*)
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  22. Address:(*)
    Invalid Input
  23. Postcode:(*)
    Invalid Input
  24. Information on others at risk, please add any further information we should know here, such as children at risk.(*)
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  25. Relationship to the subject:(*)
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  26. Date of birth (if known):
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  27. Gender:(*)
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  28. Ethnic Origin:(*)
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  29. Details of the subject

  30. Full Name:(*)
    Please let us know your full name.
  31. Tel:(*)
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  32. Address:(*)
    Invalid Input
  33. Postcode:(*)
    Invalid Input
  34. Relationship to offender:(*)
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  35. Date of birth (if known):
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  36. Gender:(*)
    Invalid Input
  37. Ethnic Origin:(*)
    Invalid Input
  38. Please enter the validation code shown(*)
    Please enter the validation code shown RefreshInvalid input please try again

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