Outgoings: Your living costs Income: What money do you receive?

Enter the total amount you pay including How often? e.g. Average per Payment amount How often? E.g. Average per calendar
Payment amount £ If income is variable enter an average
towards arrears you may have weekly, monthly calendar month £ weekly, monthly month
HOUSING & UTILITY BILLS Your wage
Rent You partner's wage
Mortgage Part-time wages
Secured loan (other than your mortgage) Child benefit
Mortgage endowment premium Rent or board received
Service charge or ground rent State pension
Water Private pensions
Council tax Pension credit
Gas Universal credit
Electricity Employment & Support Allowance (ESA)
Other household fuels (oil, coal etc) Jobseeker's Allowance (JSA)
HOUSEHOLD SERVICES Child Support or CSA
Buildings & contents insurance Disability Living Allowance (DLA)
Telephone and internet Income Support
TV licence Working Tax Credit
Satellite or cable TV Child Tax Credit
Repairs, service contracts Housing Benefit
Appliance rental
Child support paid by you TOTAL INCOME £0
Childcare
Life insurance & private pension
Medical or accident insurance
Debts: Who do you owe money to? (This could include rent arrears, gas or electricity, credit and store cards, bank loans etc.)
TRAVEL Name of organisation or lender Type of debt Amount owed Usual payment How often? Per calendar month
Spares & servicing Example: ABC Bank Overdraft £1,000.00 £100.00 Monthly 100
Road tax
Car insurance
Breakdown cover
Fuel & parking
Public transport
FOOD & HOUSEKEEPING
Food, toiletries & cleaning products
School meals
Meals at work
Pets (food & insurance)
Tobacco
Clothing & footwear
OTHER SERVICES TOTAL DEBT £0 TOTAL DEBT PAYMENTS £0
School trips & activities
Medicines & prescriptions
Dentist & opticians
Court payments
Hairdressing Type of court order Amount owed Usual payment How often? Per calendar month
Professional or union fees County Court judgment (CCJ) £2,000.00 £17.50 Weekly 75.83
Education fees
Laundry or dry cleaning
PERSONAL & LEISURE
Newspapers & magazines
Sports, hobbies & entertainment
Children's pocket money TOTAL COURT DEBT £0 TOTAL COURT PAYMENTS 0.00
Church or charity donations
Sundries & emergencies
OTHER COSTS
Assets: What do you own?
Type of asset Estimated value Note:
Vehicle £4,000.00
If you've entered details of any property you
own, we may ask for details of your
remaining mortgage and equity. It helps to
have this ready when you speak to us.

TOTAL EXPENSES £0 TOTAL ASSETS £0