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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
Your wage
Your partner's wage
Part-time wages
Child benefit
Rent or board received
State pension
Private pensions
Pension credit
Employment & Support Allowance (ESA)
Jobseeker's Allowance (JSA)
Child Support or CSA
Disability Living Allowance (DLA)
Income Support
Working Tax Credit
Child Tax Credit
Housing Benefit
Total Income £ 0.00
Outgoings: Your monthly living costs
Enter the total amount you pay including towards arrears you may have Payment amount £
Housing & Utility Bills
Secured loan (other than your mortgage)
Mortgage endowment premium
Service charge or ground rent
Council tax
Other household fuels (oil, coal etc)
Household Services
Buildings & contents insurance
Telephone and internet
TV licence
Satellite or cable TV
Repairs, service contracts
Appliance rental
Child support paid by you
Life insurance & private pension
Medical or accident insurance
Spares & servicing
Road tax
Car insurance
Breakdown cover
Fuel & parking
Public transport
Food & Housekeeping
Food, toiletries & cleaning products
School meals
Meals at work
Pets (food & insurance)
Clothing & footwear
Other Services
School trips & activities
Medicines & prescriptions
Dentist & opticians
Professional or union fees
Education fees
Laundry or dry cleaning
Personal & Leisure
Newspapers & magazines
Sports, hobbies & entertainment
Children's pocket money
Church or charity donations
Sundries & emergencies
Debts owed to other Creditors
Total Outgoings £ 0.00

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01386 719130