This form is for your own personal use to print out and keep if required.
Please use your mouse to select a box and Tab to move between boxes
STEP 1
Income
STEP 4 PRIORITY DEBTS
Bal Owed
Repayment
STEP 2 Outgoings
Total priority debts balance
Mortgage endowment policy
Money for creditors BOX C
£
Council Tax
Total priority repayment BOX D
£
Water rates
Money for credit debts BOX E
£
Ground Rent/Service charge
STEP 6
Credit
Debts
Buildings/contents insurance
Name of Creditor
Balance owed
Offer of repayments
School meals/meals at work
Total Owed BOX F £
Clothing
Total monthly repayment
BOX G £
Telephone/mobile phone
This is an accurate record of my
Prescriptions/health costs
financial position at
Total for Creditors BOX C £