Financial Statement Page 3
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12Part D
Your income
GIVE WEEKLY AMOUNTS IN WHOLE DOLLARS. IF THE AMOUNT FOR AN ITEM IS NIL, WRITE ‘NIL’.
NOTE:
IF YOU CAN ONLY GIVE AN ESTIMATE INSERT THE LETTER ‘E’ BEFORE THE AMOUNT STATED
AVERAGE WEEKLY AMOUNT
9
Total salary or
$
wages before
tax
Investment
10
INCOME TYPE (eg. rent, interest, dividend)
$
income (before
tax)
PAID BY (bank, mortgagor, company, tenant)
INCOME TYPE (eg. rent, interest, dividend)
$
PAID BY (bank, mortgagor, company, tenant)
11
Income from
NAME OF BUSINESS/ PARTNERSHIP/ COMPANY/ TRUST
$
business/
partnership/
company/ trust
TYPE OF BUSINESS
ADDRESS OF BUSINESS/ PARTNERSHIP/ COMPANY/ TRUST
State
Postcode
Government
$
TYPE OF BENEFIT
12
benefits
$
TYPE OF BENEFIT
Maintenance/
13
PAID BY
child support
FOR THE BENEFIT OF
$ REQUIRED TO BE PAID
ACTUALLY RECEIVED
$
$
PAID BY
$ REQUIRED TO BE PAID
FOR THE BENEFIT OF
ACTUALLY RECEIVED
$
$
Benefits from
$
14
TYPE OF BENEFIT
employment/
business
$
TYPE OF BENEFIT
Other income
15
$
PAID BY
TYPE OF BENEFIT
TOTAL AVERAGE WEEKLY INCOME
$
16
WRITE THE ITEM 16 TOTAL AT ITEM 2A ON PAGE 2 OF THIS FORM
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