Common Financial Statement Summary

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COMMON FINANCIAL STATEMENT SUMMARY
All amounts are monthly
Client Address
Agency
Case Reference
Caseworker
License No
Number in household
Dependent children under 14
Number of vehicles in household
Dependent children aged 14+
Monthly Income
£ Amount
Priority Debts
£ Owed
£ Offer
4a
Monthly Total Salary / Wages
88
Rent
9a
Monthly Total Other Income
89
Mortgage
21a Monthly Total Benefits
90
Other Secured Loans
25a Monthly Total Pensions
91
Magistrates' Court Fines
Monthly Total Salary / Wages
92
Council Tax
Please confirm you have discussed the use of
93
Maintenance / Child Supp
94
Gas
any assets to make lump sum payments
95
Electricity
Monthly Expenditure
£ Amount
32
Rent
96
Hire Purchase
33
Ground Rent / Service Charge
97
Other
34
Mortgage
98
Other
35
Other Secured Loans
Total Priority Debts
36
Mortgage Endowments and MPPI
37
Buildings / Contents Insurance
Non Priority Debts
£ Owed
CCJ
£ Offer
38
Pensions and Life Insurance
101
39
Council Tax
102
40
Gas
103
41
Electricity
104
42
Water
105
43
Other Utilities
106
44
TV License
107
45
Magistrates' court fines
108
46
Maintenance or Child Support
109
47
Hire Purchase / Conditional Sale
110
48
Childcare Costs
111
49
Adult Care Costs
112
50
Other
113
51
Other
114
52
Other
115
55a Total Phone
116
64a Total Travel
117
74a Total Housekeeping
118
87a Total Other Expenditure
119
Monthly Total Expenditure
Total Non Priority Debts
Total Available for Creditors
Total for Non-Priority Creditors
This financial statement is an accurate record
Signed
of the information provided by our client(s).
Dated

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