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Income and expenditure financial statement

If you are experiencing financial difficulties, we urge you to contact us so that we can gain an understanding of your current situation and consider the most appropriate action to take. Additionally, the following organisations can provide independent advice and free debt counselling. Tel: 0800 138 1111 Tel: 0800 280 2816 Tel: 01274 760720 Tel: 0808 808 4000 Tel: 0800 138 7777 Tel: 03444 111 444 (England) 03444 77 20 20 (Wales)

This template can be used to assist you in establishing your current income and expenditure. Please take the time to go through the figures you've listed and work out what installment payments you can realistically offer and then advise us accordingly.

Income: What money do you receive per month?
If income is variable enter an average Amount (£)
Salary or wages (take home)
Partner salary or wages (take home)
Other earnings (including self employment)
Benefits and tax credits
Universal Credit
Jobseeker's Allowance (income based)
Jobseeker's Allowance (contribution based)
Income Support
Working Tax Credit
Child Tax Credit
Child Benefit
Employment and Support Allowance or Statutory Sick Pay
Disability benefits
Carer's Allowance
Local Housing Allowance / Housing Benefit
Council Tax support
Other benefits/tax credits (e.g. maternity benefits)
State pensions
Private or work pensions
Pension credit
Other pensions
Other income
Maintenance or child support
Boarders or lodgers
Non-dependants' contributions
Student loans and grants
Other income
Monthly total income £ 0.00
Assets or Equity
Amount (£)
House or Flat
Total value of property(ies)
Mortgage outstanding
Secured loan(s) outstanding
Other assets
Value of vehicle(s) (less HP outstanding)
Other assets
Total Assets and Equity £ 0.00
Monthly Outgoings: Fixed costs
Enter the total amount you pay including towards arrears you may have Amount (£)
Housing & Utility Bills
Ground rent & service charges
(factor fees if you live in Scotland)
Mortgage endowment
Secured loans
Council tax/rates (including water charge if you live in Scotland and rates in NI)
Appliance & furniture rental (including appliance and furniture HP, conditional sale and so on)
TV licence
Other costs
Other costs (including coal, oil, calor gas etc.)
Water supply
Water waste
Care and health costs
Childcare costs
Adult-care costs
Child maintenance or child support
Prescriptions and medicines
Dentistry and opticians
Other costs
Transport and travel
Public transport (e.g. work, school, shopping)
Hire Purchase or conditional sale vehicle
Car insurance
Road tax
MOT and ongoing maintenance
Breakdown cover
Fuel, parking and toll road charges
Other costs (including taxis)
School costs
School uniform
After-school clubs and school trips
Other costs
Pensions and insurances
Pension payments
Life insurance
Mortgage payment protection insurance
Buildings and contents insurance
Health insurance (medical or accident or dental)
Other costs
Professional costs
Professional courses
Union fees
Professional fees
Other essential costs
Monthly total fixed cost outgoings £ 0.00
Monthly Outgoings: Flexible costs
Amount (£)
Communications and leisure
Home phone, internet, TV package (including film subscriptions)
Mobile phone
Hobbies, leisure or sport
(e.g. socialising, eating out, outings, clubs, leisure courses)
Gifts (e.g. birthdays, festivals, charity donations)
Pocket money
Newspapers, magazines, stationery and postage
Other costs
Food and housekeeping
Groceries (e.g. food, pet food, non-alcoholic drinks, cleaning)
Nappies and baby items
School meals and meals at work
Laundry and dry cleaning
Smoking products
Vet bills & pet insurance
House repairs and maintenance
Other costs
Personal costs
Clothing and footwear
Other costs
Monthly total flexible cost outgoings £ 0.00
Amount (£)
Debt Administration Fee
Priority debts
Non-Priority debts
Total debts £ 0.00

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