Financial Statement
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1
2
3Financial Statement
Name
Address
Dated………………………………………………
Income
Current
Proposed
(Weekly/Monthly/4 Weekly)
Wages/Salary
Wages (take home pay)
Partners Wages (take home pay)
Benefits
1.
2.
3.
4.
5.
6.
Other Income
Maintenance/Child Support
Money from Non-Dependants
Occupational/ Private Pensions
Income from Savings
Other
TOTAL INCOME
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