Dealing with Financial Difficulty

Income & Expenditure

Your Information

We collect and process various categories of personal and financial information throughout your relationship with us, to allow us to provide our products and services and to run our business. For more information about how we use your personal information, the types of information we collect and process and the purposes for which we process personal information, please read our Privacy Notice.

We may update this from time to time and we encourage you to visit our website regularly to stay informed of the purposes for which we process your information and your rights to control how we process it.

Your Personal Details

First Name *

Surname *

Sort Code

Account Number

Add dependents? A financial dependant is anyone who relies on you financially for things like money, clothes or food. This might include children, relatives, spouses or friends.

Yes

How many dependents do you have? *

Income

Your salary * How much do you get paid per month?

Joint applicant salary ( If applicable)

Does your household receive any other income? e.g. bonus/commission/overtime, benefits or income from savings/investments

Yes

Other income How much do you receive each month from your other income source(s). If you have multiple other income souces, please enter the total

Details of other income Please describe your other source(s) of income in the free text field below

Expenditure

Household Expenses

House Insurance

Local authority rates/ Council/Property tax

Water

Gas

Electric

Oil/Fuel

Telecom/ Mobile/ Internet

Property Maintenance

Travel Expenses e.g. parking/petrol

Car Services/ Repairs

Leisure/ recreation/ entertaining

Other property costs e.g. Ground rent/Service charge

Domestic help/ Child minder/ School/ Nursery fees

Food/Other expenditure

TV rental/Licence /Satellite subscription

Clothing

Food/Other expenditure

Holidays

Commitments

Mortgage/Rent

Healthcare

Pension contributions /Premiums

Life cover premiums

Maintenance payments

Car tax and insurance

Loans/Hire purchase

Credit card and store card payments

Savings and investment payments

Savings & Investments

Bank

Building Society

Credit card and store card payments

Pensions

Endowment Plans

ISA/SAYE

Do you own your home? (Owned outright or mortgaged)

Yes

Property Value

Mortgage Outstanding

Other Property Values

Other Mortgages

Debts & Other Liabilities

Please list your debts/liabilities below * Please include: Creditor Name, Type of Debt, Amount Owed, Monthly Repayment, Expiry Date

Repayment Strategy If any of your liabilities are Interest Only, how do you plan to repay them?

Form submitted successfully

Important

If you have not already done so, you must get in touch with us so that one of our team can review your Income & Expenditure form with you

Get in Touch

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