Income Expenditure Form

Download it here

Outgoings: Your living costs

 

Enter the total amount you pay including towards arrears you may have

Payment amount £

How often? e.g. weekly, monthly

Average per calendar month

 

HOUSING & UTILITY BILLS   

 

Rent

 

Monthly

£0

 

Mortgage  

       

Secured loan (other than your mortgage)

       

Mortgage endowment premium

       

Service charge or ground rent

       

Water

 

Monthly

£0

 

Council tax

 

Monthly

£0

 

Gas

       

Electricity

       

Other household fuels (oil, coal etc)

       

HOUSEHOLD SERVICES

 

Buildings & contents insurance

       

Telephone and internet

 

Monthly

£0

 

TV licence

       

Satellite or cable TV

       

Repairs, service contracts

       

Appliance rental

       

Child support paid by you

       

Childcare

       

Life insurance & private pension

       

Medical or accident insurance

 

Monthly

£0

 

TRAVEL

 

Spares & servicing

       

Road tax

 

Yearly

£0

 

Car insurance

 

Yearly

£0

 

Breakdown cover

       

Fuel & parking

 

Fortnightly

£0

 

Public transport

 

Monthly

£0

 

FOOD & HOUSEKEEPING

 

Food, toiletries & cleaning products

 

Monthly

£0

 

School meals

 

Weekly

£0

 

Meals at work 

       

Pets (food & insurance)

       

Tobacco

       

Clothing & footwear

 

Monthly

£0

 

OTHER SERVICES

 

School trips & activities

       

Medicines & prescriptions

       

Dentist & opticians

       

Hairdressing

 

Monthly

£0

 

Professional or union fees

       

Education fees

       

Laundry or dry cleaning

 

Monthly

£0

 

PERSONAL & LEISURE

 

Newspapers & magazines

       

Sports, hobbies & entertainment

       

Children’s pocket money

 

Weekly

£0

 

Church or charity donations

       

Sundries & emergencies

       

OTHER COSTS

 
         

TOTAL EXPENSES 

£0

 
         
         
         

Income: What money do you receive?

 

If income is variable enter an average

Amount

How often?

Per calendar month

 

Your wage

 

Monthly

£0

 

You partner’s wage

       

Part-time wages

       

Child benefit

£82.60

Monthly

£83

 

Rent or board received

       

State pension

       

Private pensions

       

Pension credit

       

Employment & Support Allowance (ESA)

       

Jobseeker’s Allowance (JSA)

       

Child Support or CSA

£50.00

     

Disability Living Allowance (DLA)

       

Income Support

       

Working Tax Credit

       

Child Tax Credit

£64.62

     

Housing Benefit

       

Universal Credit

       
         

TOTAL INCOME 

£83

 
         

Debts: Who do you owe money to?

(This could include rent arrears, gas or electricity, credit cards bank loans etc.)
         
Name of organisation or lender Type of debt Amount owed Usual payment How often?
Example: ABC Bank Overdraft £1,000.00 £100.00 Monthly
         
         
TOTAL DEBT £0 TOTAL DEBT PAYMENTS
         

Court payments

Type of court order Amount owed Usual payment How often? Per calendar month
County Court judgment (CCJ) £2,000.00 £17.50 Weekly £76
TOTAL COURT DEBT #REF! TOTAL COURT PAYMENTS #REF!
         

Assets: What do you own?

     
     
Type of asset Estimated value      
Vehicle £4,000.00      
Vehicle £3,000.00      
TOTAL ASSETS £3,000      
         
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