Restons Solicitors - Financial Statement

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Complete a Financial Statement

Getting clear on the things you spend your money on, and the money you have coming in is a great step to understanding your overall financial position.

Restons Reference
Address
Contact Information
Marital Status
Residential Status
Household Details

Employment Status
Employment Details

Property Details 1
Property Details 2
Bank and Savings

Earnings
Benefits
Pensions
Other Income

Priority Bills
Home and Contents
Care and Health costs
Food and Housekeeping
Transport and Travel
Pensions and Insurances
Communications and Leisure
School costs
Personal costs
Professional costs
Other Costs

Priority Bill Arrears
Other Creditors

Offer

Restons Reference* This number can be found on letters, SMS texts or emails we have sent to you previously
Postcode*
Date of Birth*

Password*
Confirm Password*

Name*
Full Address*
Postcode*

Consent to contact via SMS Yes No
Telephone Number
Mobile Number*
Email Address*
Consent to contact via Email Yes No

	Homeowner
	Tenant (Private)
	Tenant (Social)
	Living with parents
	Other

	Married/Civil Partnership
	Single
	Co-habiting
	Divorced
	Widowed


Number of Adults in Household (over 18 years)*
Number of Dependent Children under the age of 16*
Number of Dependent Children aged 16-18*
Number of Vehicles in the Household*

	Full time
	Part time
	Self-Employed
	Retired
	Carer
	Student
	Unemployed
	Not working due to illness / disability
	Other

Name:*
Address:*
Contact Telephone No.:
Time at Employer:
Job Title:
Nature of Business:
Paid:*	Weekly Fortnightly Four-Weekly Monthly
Hours Worked per Week:*
Pay Date / Pay Day:*

	Monthly Amount
Ground rent & service charges
Secured loans
TV Licence

	Monthly Amount
Rent
Mortgage
Council tax/Rates
Water supply
Gas
Electricity

Are any of your priority bills in arrears?

Yes No

	Monthly Amount
Childcare costs
Adult-care costs
Child maintenance or child support
Prescriptions and medicines
Dentistry and opticians

	Monthly Amount
Groceries (e.g. food, pet food, non-alcoholic drinks, cleaning)
Nappies and baby items
School meals and meals at work
Laundry and dry cleaning
Alcohol
Smoking products
Vet bills & pet insurance
House repairs and maintenance

	Monthly Amount
School uniform
After school clubs and school trips

	Monthly Amount
Clothing and footwear
Hairdressing
Toiletries

	Monthly Amount

	Monthly Amount
Public transport (e.g. work, school, shopping)
Hire purchase or conditional sale (Vehicle Loan)
Duration of agreement (months):
Agreement End Date: (dd/mm/yyyy)
Car insurance
Road tax
MOT and ongoing maintenance
Breakdown cover
Fuel, parking and toll road charges

	Monthly Amount
Pension payments
Life insurance
Mortgage payment protection insurance
Buildings & contents insurance
Health insurance (medical, accident or dental)

	Monthly Amount
Home phone, Internet & TV package (including film subscriptions)
Mobile phone
Hobbies, leisure or sport (e.g. socialising, eating out, outings, clubs, leisure courses)
Gifts (e.g. birthdays, festivals & charity donations)
Pocket money
Newspapers, magazines, stationery & postage

	Monthly Amount
Professional courses
Union fees
Professional fees

	Monthly Amount
Other hire purchase agreements
Duration of agreement (months)
Agreement End Date: (dd/mm/yyyy)
Regular Savings(e.g. Savings accounts, Xmas club, etc.)
Total Debt admin fee per month (if applicable)

Total Monthly Expenditure (A)

	Monthly Amount
Your Net Income (Your income after Tax + National Insurance)*
Partner’s Net Income

Total

Do you recieve any benefits?

Yes No

	Monthly Amount
Child Benefit
Child Tax Credit
Universal Credit
Jobseeker’s Allowance (income based)
Jobseeker’s Allowance (contribution based)
Income Support
Working Tax Credit
Employment and Support Allowance or Statutory Sick Pay
Disability benefits
Carer’s Allowance
Local Housing Allowance / Housing Benefit
Council Tax support

Total

	Monthly Amount
State pensions
Private or work pensions
Pension credit

Total

	Monthly Amount
Maintenance or child support
Boarders or lodgers
Non-dependants’ contributions
Student loans and grants

Total

Total Monthly Income (B)

Creditor Name(s)	Monthly Payment Amount	Amount Owed






Total Repayments

Details of any Priority Bill arrears and arrangements for the repayment of the arrears (i.e. Mortgage/Rent, Gas, Electricity, Water and Council Tax) Do not include any amounts detailed within your Monthly Expenditure in Section.	Amount Repaying	Amount Owed






Total Repayments

	Monthly Amount
Total Monthly Income
Total Monthly Expenditure
Total Monthly Creditor Repayments
Total Available for Creditors & Priority Bill Arrears ([B-A] Amount B minus Amount A)
Total Disposable Income (Expenditure - Income - Creditor Repayments)
Offer of Payment*

I confirm that the above information is correct to the best of my knowledge. Dated:


Address of Property Owned
Purchased for		Date Of Purchase*
Amount of Mortgage		Current Value
Arrears Due
Period of Mortgage Remaining	Years		Months
Details of any registrations on your property e.g. Second Mortgage or Secured Loans
Amount Due		For Sale	Yes No

Do you own a second property?

Yes No

Property Type	Investment Buy to Let Inherited Owned with former spouse
Address of Property Owned
Purchased for		Date Of Purchase
Amount of Mortgage		Current Value
Arrears Due
Period of Mortgage Remaining	Years		Months
Details of any registrations on your property e.g. Second Mortgage or Secured Loans
Amount Due		For Sale	Yes No


Name and Branch of Bank
Type of Account		Balance