Income & Expenditure Form

Your Details

Your Household

Income

Wages/Salary

Partner's Wages/Salary

Benefits

Pensions

Other Income

Total

Expenditure

Rent/Mortgage

Council Tax

Service Charges

Water Charges

House Contents Insurance

Life Insurance

Gas

Electricity

Other Fuel

Prescription/Health Costs

Telephone

Mobile Telephone

TV License

HP/Conditional Sale

Groceries

Clothing/Footwear

Childcare

Pet Food/Vet

School Meal/Expenses

TV/Subscriptions

Health Costs

Car Costs - Petrol

Car Costs - Insurance

Car Costs - Parking

Haircuts

Travel

Miscellaneous

Total

Priority Debts

Balance

Rent/Mortgage Arrears

Council Tax

Income Tax

Electricity

Water

Other Utilities

Other Secured Loans

Court Fines

Wage Attachments

Maintenance/Child Support

Total

Payment

Rent/Mortgage Arrears

Council Tax

Income Tax

Electricity

Water

Other Utilities

Other Secured Loans

Court Fines

Wage Attachments

Maintenance/Child Support

Total

Other Debts

Priority Debt

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Balance

Payment

Totals:

Balance

Payment

Other Debts

Additional Comments

Repayment

Offer of Repayment:

Replayment Frequency:

WeeklyMonthly

Please be aware that arrangements are discretionary, we are not obliged to accept any offer of repayment from you.

Before any arrangement is considered you are required to provide 3 months of recent bank statements and/or supporting evidence.

Failure to adhere to this request may result in enforcement action, that may incurr you further costs, being taken without further notice.

Supporting Documents

You may upload up to 3 files. Maximum size per file is 4MB

Choose file

Feel free to write

Get in touch with us

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Have any question?

+44 1622 683308

Write email

info@stanfordandgreen.co.uk

Visit anytime

PO Box 313, Faversham, Kent, ME13 3EE