Example Financial Statement
Income (per week/fortnight/month)
£
________ Wages
________ Wages (partners)
________ Maternity Pay/Allowance
________ Child Benefit
________ Working Tax Credit and or Child Tax Credit
________ Jobseeker's Allowance
________ Income Support
________ Retirement Pension
________ Occupational Pension
________ Pension Credit/Other Pension
________ Paternity/Adoption Pay
________ Industrial Disablement Benefit
________ Bereavement/Widowed Parent's Allowance
________ Maintenance/CSA
________ Statutory Sick Pay
________ Disability Living/Attendance Allowance
________ Incapacity Benefit
________ Carer's Allowance
________ Maintenance/CSA
________ Boarder/Lodger
________ Other Income
________ Total
TOTAL INCOME (per week/fortnight/month) £
Essential Expenditure (per week/fortnight/month)
£
________ Rent (less Housing Benefit)
________ Mortgage
________ Endowment Policy
________ Council Tax (current year)
________ Water Charges
________ Electricity
________ Gas
________ Other Fuel
________ Housekeeping
________ Clothing/Shoes
________ Maintenance/CSA
________ Travel Costs
________ Health Costs
________ Fines
________ Hire Purchase
________ Rentals
________ Telephone/Mobile
________ TV Costs (rental/licence)
________ Family and Personal
________ Rent Arrears
________ Mortgage Arrears
________ Service Charges
________ Council Tax (arrears)
________ Poll Tax Arrears (to 1993)
________ House Insurance
________ Life Insurance
________ Childcare Costs
________ School Travel
________ School Meals
________ Maintenance Arrears
________ Car Costs
________ Disability Needs (see DLA)
________ County Court Orders
________ HP Arrears
________ House Upkeep
________ Newspapers etc
________ Other
________ Other
________ Total
TOTAL EXPENDITURE £
_________________________
SPARE INCOME £
_________________________
Pro-Rata Offer
Total Debt = £
Spare Income = £
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