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Personal Details
Title |
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Full name |
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Full home address |
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Do you own this property? |
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Type of accommodation |
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Marital status |
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Date of birth |
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Home telephone |
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Work telephone |
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Mobile telephone |
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Email address |
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Employment |
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Employer |
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Does your partner or spouse work? |
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Number of children |
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Ages of children |
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Is the property being purchased on a shared ownership basis with a housing association or builder? |
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Current mortgage lender |
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Current amount of mortgage |
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Repayment |
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Mortgage arrears |
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Loan or credit card payments |
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Is there a second charge against the property? |
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Who is the second charge holder? |
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How much is owed? |
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Is the property owned solely or jointly with a partner or spouse? |
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Personal Vehicles
How many vehicle do you own |
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Is there any finance attached to any of the vehicles |
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Amount outstanding |
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Monthly payments |
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Agreement end date |
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Monthly Income
Net salary take home pay |
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Partners net basic salary take home pay |
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Child benefit |
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Pension income |
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Family tax credit |
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Income support |
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Housing benefit |
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Unemployment benefit |
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Maternity benefit |
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Invalidity allowance |
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Maintenance from ex partner or spouse |
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Rent from lodger |
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Board from children |
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Other income |
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Self employment income |
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Monthly Expenditure
Mortgage |
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Mortgage arrears |
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Rent |
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Rent arrears |
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Second mortgage or charge |
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Board paid to parents or landlord |
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Endowment payments |
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Buildings and contents insurance |
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Council tax |
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Gas |
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Electricity |
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Water rates |
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Telephone |
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Internet |
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Mobile telephones |
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TV license |
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Digital TV |
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Life insurance |
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Health insurance |
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Childcare |
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Food and household |
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Lunches at work |
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Clothing including family |
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Voluntary support or CSA payments |
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Maintenance order payments to ex spouse |
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Loan or credit card payments |
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Tax on self employment income |
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Public transport |
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Travelling Expenses
Vehicle hire purchase |
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Vehicle tax |
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Vehicle insurance |
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Petrol or diesel |
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Vehicle maintenance |
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Totals
Total expenditure |
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Total income |
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Disposable income |
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Credit card or loan payments |
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Comments / Notes |
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