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