INCOME & EXPENDITURE STATEMENT

1. Income (use all monthly or all weekly figures)

3. Priority Debts

Wages/Salary

 

All Arrears

Outstanding

Balance

Payment Offer

Wages/Salary (spouse)

 

Mortgage

 

 

Family Credit

 

Rent

 

 

Benefits

 

Council Tax

 

 

Pension

 

Water Rates

 

 

Child Benefit

 

Gas

 

 

Other

 

Electric

 

 

Other

 

Court Fines

 

 

A. Total Income

 

Maintenance

 

 

2. Living Costs

Other    

Mortgage

 

Other

 

 

Rent

 

D. Total Priority Debt Payment

 

Council Tax

 

C less D =4. Money for

 Non-priority Debts

 

Water Rates

 

Creditors Name

Balance Owed

Offer

Home Insurance

 

1.

 

 

Life Insurance etc.

 

2.

 

 

Electric

 

3.

 

 

Gas

 

4.

 

 

TV Licence

 

5.

 

 

Court Fines

 

6.

 

 

Maintenance

 

7.

 

 

Travelling Expenses

 

8.

 

 

Clothing

 

9.

 

 

School & Work Costs

 

Total Owed

 

 

Telephone

 

Offer Total 

 

 

Housekeeping

 

 

 

 

Other

 

 

 

 

B. Total Living Costs

 

 

A less B = C. Money for Creditors

 

 

Name ………………………………………….....................................................................................

Address ……………...…………….………………………………………………………………………………

Signature ……………………………...................……………. Date ……................……………………....

I/we agree that the above statement is a true record of the facts.