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INCOME & EXPENDITURE STATEMENT |
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1. Income (use all monthly or all weekly figures) |
3. Priority Debts |
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Wages/Salary |
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All Arrears |
Outstanding Balance |
Payment Offer |
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Wages/Salary (spouse) |
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Mortgage |
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Family Credit |
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Rent |
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Benefits |
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Council Tax |
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Pension |
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Water Rates |
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Child Benefit |
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Gas |
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Other |
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Electric |
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Other |
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Court Fines |
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A. Total Income |
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Maintenance |
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2. Living Costs |
Other | |||||
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Mortgage |
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Other |
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Rent |
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D. Total Priority Debt Payment |
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Council Tax |
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C less D =4. Money for Non-priority Debts |
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Water Rates |
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Creditors Name |
Balance Owed |
Offer |
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Home Insurance |
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1. |
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Life Insurance etc. |
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2. |
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Electric |
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3. |
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Gas |
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4. |
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TV Licence |
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5. |
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Court Fines |
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6. |
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Maintenance |
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7. |
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Travelling Expenses |
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8. |
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Clothing |
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9. |
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School & Work Costs |
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Total Owed |
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Telephone |
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Offer Total |
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Housekeeping |
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Other |
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B. Total Living Costs |
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A less B = C. Money for Creditors |
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Name …………………………………………..................................................................................... Address ……………...…………….……………………………………………………………………………… Signature ……………………………...................……………. Date ……................…………………….... I/we agree that the above statement is a true record of the facts. |
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