Energy Advice and Support Service – SELF REFERRAL (Kayo) Step 1 of 2 50% There is currently a high demand for our Energy Advice and Support Service. We aim to respond to you within two weeks. Please complete the form below with all of the information that we have requested. It will help us more quickly deal with your enquiry.Consent(Required) By ticking this box you confirm that:You are aware your personal details will be kept by NEA for the purpose of completing this referral. Any information you supply will be stored and processed according to NEA’s Privacy Notice. Your detailsYour name(Required) Forename Surname Your address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Your telephone number(Required)Can a message be left on this number? Yes No Your email address (if you have one) Enter Email Confirm Email Your date of birth DD slash MM slash YYYY Your ethnicitySELECTAsian or Asian British BangladeshiAsian or Asian British IndianAsian or Asian British Other BackgroundAsian or Asian British PakistaniBlack or Black British AfricanBlack or Black British CaribbeanBlack or Black British Other BackgroundChineseEastern EuropeanMixed Other BackgroundMixed White & AsianMixed White & Black AfricanMixed White & Black CaribbeanRomany, Gypsy, TravellerWhite BritishWhite IrishWhite OtherOtherPrefer not to sayDo you require translation/interpretation services? Yes No If yes, please select which languageSELECTAfrican – OtherArabicBengaliChineseEnglishFarsiFrenchGaelicGermanGujeratiHindiKurdishPakistaniPashtunPolishPunjabiRomanianSign LanguageSomaliTurkishUrduVietnameseWelshOther informationWho is your electricity supplier? What type of electricity meter do you have?SELECTElectric – Smart – CreditElectric – Smart – PPMElectric – Traditional – CreditElectric – Traditional – PPMDo not knowWho is your gas supplier? What type of gas meter do you have?SELECTGas – Smart – CreditGas – Smart – PPMGas – Traditional – CreditGas – Traditional – PPMNo Gas SupplyDo not knowHow can we help you?(Required)Please give as much information so that we know which member of the team will best help you.If you are able to, please upload a copy of your proof of benefits. This will speed up the process a little, but don't worry if you're unable do to this right now.Max. file size: 10 MB.