Debt management Monthly Financial Statement


Fill in the form to workout if you are in control of your finances and ow you spend your hard earned income each month


   
 

Monthly Financial Statement

  
 
                 
  Date:            
  Applicant Name:            
  Partner Name:            
  Current Address:            
  Town/City            
  County:            
  Post Code:            
  Number of people in the household:            
  Number of children:            
  Children Ages:            
                 
  Amount quoted is nearest to the £            
  Income              
  1st Salary            
  2nd Salary            
  Part Time Job            
  Family Credit            
  Income Support            
  Incapacity Benefit            
  Child Benefit            
  Unemployment Benefit            
  Disability Benefit            
  Retirement Pension            
  State Pension            
  Maintenance            
  Contributions            
  Rent and Other income            
                 
  Total Monthly Income            
                 
 
   Amount quoted is nearest to the £            
  Essential Expenditure              
  Rent            
  Ground rent & service charges            
  Mortgage            
  Secured Loans            
  Endowment and MPPI            
  Building and contents insurance            
  Pension and life insurance            
  Council Tax            
  Gas            
  Electricity            
  Water            
  TV licence should £12.00 a month            
  Court fines            
  Maintenance or child support            
  Hire Purchase / conditional sale            
  Childcare costs            
  Adult care costs            
  Other            
                 
  Phone Bills              
  Home phone Land line            
  Mobile phone/s            
  Internet Package with Home phone land line            
  Other            
                 
  Travel Expenses              
  Public transport (work, school,
shopping, taxi etc)		            
  Car insurance            
  Road tax            
  Fuel (Petrol, Diesel, Oil etc)            
  MOT and car maintenance            
  Breakdown or recovery            
  Parking charges or tolls            
  Other            
                 
  Housekeeping              
  Groceries            
  Clothing and footwear            
  Dentist, glasses, prescriptions,
hairdressing		            
  Meals at school and at work            
  Pet food            
  Vet bills and pet insurance            
  Household Repairs            
  Other            
  Total Monthly Expenditure            
                 
   Monthly Income less Monthly 
 Expenditure = Amount Available to pay
 to your Creditors (Disposable Income)		            
                 
  Fill the amount you owe to your creditors to calculate the pro rata payments  
  Amount you owe to your creditors to the Nearest £  
  Your Disposable Income   £        
  Creditor Account Number   Debt     Pro Rata  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  £   £  
  Total amount you owe to your CREDITORS £      
                 
  Information provided is an accurate record of my/our finances and I am willing to provide documentary proof if required.  
  Applicant Signature:            
  Partner Signature:            
  Date Financial Statement signed:            

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