Budget Planner & Statement of Assets & Liabilities Appendix 2

Name: Date:
Monthly
Income (please state source) 0
0
Total income 0
Outgoings (give details)
Mortgage and/or rent (delete as appropriate) 0
Council Tax
Water Rates
Utilities (gas, electricity, fuel etc)
Personal and Property Insurance
General Housekeeping expenses (inc food)
Telephone
Car Tax and insurance
Car running expenses (fuel, repairs/maintenance)
HP repayments
Hire charges (TV, video etc)
Subscription to journals, professional bodies, etc
Savings plans
Contingencies
T.V. license
Children’s activities
Loans
Other -
Other -
Other -
Total Outgoings 0
Monthly surplus / deficit 0

Statement of Assets & Liabilities (give details & values for all)

Value of assets owned by you (eg house, car). State if joint owner
House (address) 0
Car

Total assets 0

Liabilities - total amounts outstanding

Mortgage outstanding on house 0
Personal loan
credit card

Total liabilities 0

Signature of client to confirm the above information is accurate ________________

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