| INCOME & EXPENDITURE STATEMENT |
| 1. Income (use all monthly or all weekly figures) |
 |
3. Priority Debts |
| Wages/Salary |
|
All Arrears |
Outstanding
Balance |
|
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 for Non-priority Debts |
|
| Water Rates |
|
Creditors Name |
Balance Owed |
Offer |
| Home Insurance |
|
1. |
|
|
| Life Insurance |
|
2. |
|
|
| Electric |
|
3. |
|
|
| Gas |
|
4. |
|
|
| TV License |
|
5. |
|
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| Court Fines |
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6. |
|
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| Maintenance |
|
7. |
|
|
| Travelling Expenses |
|
8. |
|
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| Clothing |
|
9. |
|
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| School & Work Costs |
|
Total Owed |
|
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| Telephone |
|
Total Payment |
|
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| Housekeeping |
|
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| 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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