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					                                                       Revised 1        Revised 2        Revised 3        Revised 4
Your Income                             Current   Date:            Date:            Date:            Date:
Total household income        (BOX A)

                                                     Outgoings
Housing                                 Current       Revised 1        Revised 2        Revised 3        Revised 4
Rent
Mortgage
Secured loans/2nd mortgage
Mortgage endowment premium
Service charge/ground rent
Water
Council Tax
Gas
Electricity
Other Household fuel
Housing total                            € 0.00        € 0.00           € 0.00           € 0.00           € 0.00
Household services                      Current       Revised 1        Revised 2        Revised 3        Revised 4
Buildings and contents insurance
Telephone, mobile, internet
TV licence
Satellite
Repairs and maintenance
Household appliance rental
Child maintenance
Childcare
Fines, CCJ, Decrees
Life Insurance/pensions
Medical/accident insurance
Hire Purchase
Household services                       € 0.00        € 0.00           € 0.00           € 0.00           € 0.00
Transport                               Current       Revised 1        Revised 2        Revised 3        Revised 4
Vehicle spares and servicing
Road tax
Motor insurance
Vehicle breakdown
Fuel and parking
Public Transport
Transport                                € 0.00        € 0.00           € 0.00           € 0.00           € 0.00
Food and housekeeping                   Current       Revised 1        Revised 2        Revised 3        Revised 4
Food, toiletries, cleaning
School meals/meals at work
Pets, pet food/insurance
Tobacco
Food and housekeeping                    € 0.00        € 0.00           € 0.00           € 0.00           € 0.00
Miscellaneous goods and services        Current       Revised 1        Revised 2        Revised 3        Revised 4
School trips/activities
Medicines/prescriptions
Dentist/opticians
Hairdressing
Union/professional fees
Laundry/dry cleaning
Education fees
Miscellaneous goods and services         € 0.00        € 0.00           € 0.00           € 0.00           € 0.00
Personal and Leisure                    Current       Revised 1        Revised 2        Revised 3        Revised 4
Clothing and footwear
Newspapers/magazines
Sports, hobbies, entertainment
Children's pocket money
Church/charity donations
Personal and Leisure                    € 0.00          € 0.00           € 0.00           € 0.00           € 0.00
Sundries/emergencies/other              Current       Revised 1        Revised 2        Revised 3        Revised 4
Sundries/emergencies
Loan from family/friend
Other
Sundries/emergencies/other              € 0.00          € 0.00           € 0.00           € 0.00           € 0.00

Total Current Outgoings      (BOX B)    € 0.00          € 0.00           € 0.00           € 0.00           € 0.00

Current Disposable Income    (BOX C)    € 0.00          € 0.00           € 0.00           € 0.00           € 0.00
Short term savings           (BOX D)
Medium term savings         (BOX E)
Long term savings            (BOX F)

Overall Disposable Income   (BOX G)    € 0.00   € 0.00   € 0.00   € 0.00   € 0.00
     Arrears on Priority Commitments

                                           Repayment Amount
Arrears Commitment   Total Arrears   Weekly   Monthly  Monthly Total
                                                          £0.00
                                                          £0.00
                                                          £0.00
                                                          £0.00
      Total             £0.00             Total           £0.00
                    Expense Summary
               Income                                 #REF!
               Housing                                #REF!
               Household services                     #REF!
               Transport                              #REF!
               Food and housekeeping                  #REF!
               Miscellaneous goods and services       #REF!
               Personal and Leisure                   #REF!
               Sundries/emergencies/other             #REF!
               Arrears Commitment                     £0.00
                                #REF!                 #REF!




                       Miscellaneous
                        Sundries/emer
                        goods
                     Food and and
                        Household
                        Personal and
                           Arrears
                        gencies/other
                          services
                         Transport
                           Leisure
                   housekeeping#REF!
                        Commitment
                          Housing




Housing                                       Household services

Transport                                     Food and housekeeping

Miscellaneous goods and services              Personal and Leisure

Sundries/emergencies/other                    Arrears Commitment

#REF!
                                       Creditor Details
                               #REF!                                     #REF!

     Ownership of                                                        Current   Contractual
        debt        Creditor            Reference         Debt Type      Balance    Payment      Pro rata Offer
 1                                                                                                  #REF!
 2                                                                                                  #REF!
 3                                                                                                  #REF!
 4                                                                                                  #REF!
 5                                                                                                  #REF!
 6                                                                                                  #REF!
 7                                                                                                  #REF!
 8                                                                                                  #REF!
 9                                                                                                  #REF!
10                                                                                                  #REF!
11                                                                                                  #REF!
12                                                                                                  #REF!
13                                                                                                  #REF!
14                                                                                                  #REF!
15                                                                                                  #REF!
16                                                                                                  #REF!
17                                                                                                  #REF!
18                                                                                                  #REF!
19                                                                                                  #REF!
20                                                                                                  #REF!
21                                                                                                  #REF!
22                                                                                                  #REF!
23                                                                                                  #REF!
24                                                                                                  #REF!
25                                                                                                  #REF!
                                                    Total Debt (Box E)    £0.00       £0.00         #REF!
                             Name                                        Mr Alan & Mrs Ann Smith
                           Address                          123 Albert Avenue, Leeds, West Yorkshire. LS3 6JY
Housing                                       #REF!              Your Income                                      #REF!
Rent                                          #REF!              Total household income          (BOX A)          #REF!
Mortgage                                      #REF!                               #REF!                           #REF!
Secured loans/2nd mortgage                    #REF!                               #REF!                           #REF!
Mortgage endowment premium                    #REF!                               #REF!                           #REF!
Service charge/ground rent                    #REF!                               #REF!                           #REF!
Water                                         #REF!                               #REF!                           #REF!
Council Tax                                   #REF!                               #REF!                           #REF!
Gas                                           #REF!                               #REF!                           #REF!
Electricity                                   #REF!                               #REF!                           #REF!
Other Household fuel                          #REF!                               #REF!                           #REF!
Household services                            #REF!                               #REF!                           #REF!
Buildings and contents insurance              #REF!                               #REF!                           #REF!
Telephone, mobile, internet                   #REF!              Total Income                    (Box A)          #REF!
TV licence                                    #REF!
Satellite                                     #REF!                              #REF!                      Balance   Monthly
Repairs and maintenance                       #REF!                                                     0    £0.00     £0.00
Household appliance rental                    #REF!                                                     0    £0.00     £0.00
Child maintenance                             #REF!                                                     0    £0.00     £0.00
Childcare                                     #REF!                                                     0    £0.00     £0.00
Fines, CCJ, Decrees                           #REF!              Total arrears payment                       £0.00     £0.00
Life Insurance/pensions                       #REF!
Medical/accident insurance                    #REF!              #REF!
Hire Purchase                                 #REF!                              #REF!                            #REF!
Transport                                     #REF!                              #REF!                            #REF!
Vehicle spares and servicing                  #REF!                              #REF!                            #REF!
Road tax                                      #REF!
Motor insurance                               #REF!                              #REF!
Vehicle breakdown                             #REF!                              #REF!                            #REF!
Fuel and parking                              #REF!                              #REF!                            #REF!
Public Transport                              #REF!              #REF!                                            #REF!
Food and housekeeping                         #REF!              #REF!                                            #REF!
Food, toiletries, cleaning                   £456.67
School meals/meals at work                    £43.33             Creditors                                  Balance       Offer
Pets, pet food/insurance                      #REF!                                                     0    £0.00        #REF!
Tobacco                                       #REF!                                                     0    £0.00        #REF!
Miscellaneous goods and services              #REF!                                                     0    £0.00        #REF!
School trips/activities                       #REF!                                                     0    £0.00        #REF!
Medicines/prescriptions                       #REF!                                                     0    £0.00        #REF!
Dentist/opticians                              £4.15                                                    0    £0.00        #REF!
Hairdressing                                  £10.00                                                    0    £0.00        #REF!
Union/professional fees                       #REF!                                                     0    £0.00        #REF!
Laundry/dry cleaning                          #REF!                                                     0    £0.00        #REF!
Education fees                                #REF!                                                     0    £0.00        #REF!
Personal and Leisure                          #REF!                                                     0    £0.00        #REF!
Clothing and footwear                         £35.85                                                    0    £0.00        #REF!
Newspapers/magazines                          #REF!                                                     0    £0.00        #REF!
Sports, hobbies, entertainment                #REF!                                                     0    £0.00        #REF!
Children's pocket money                       #REF!                                                     0    £0.00        #REF!
Church/charity donations                      #REF!                                                     0    £0.00        #REF!
Sundries/emergencies/other                    #REF!                                                     0    £0.00        #REF!
Sundries/emergencies                          #REF!                                                     0    £0.00        #REF!
Loan from family/friend                       #REF!                                                     0    £0.00        #REF!
Other                                         #REF!                                                     0    £0.00        #REF!
                  #REF!                       #REF!                                                     0    £0.00        #REF!
                                                                                                        0    £0.00        #REF!
   I/We confirm that this is an accurate record of my/our
                                                                                                        0    £0.00        #REF!
         financial position on _____/_____/_____
                                                                                                        0    £0.00        #REF!
                                                                                                        0    £0.00        #REF!
                                                                 Total                        (Box E)        £0.00        #REF!
SPENDING TRACKER/RECEIPTS FOR WEEK:____________

Day                 Category    Notes        Amount




Categories                                   Totals
1. Housing                                   £
2. Household Services                        £
3. Transport                                 £
4. Food and Housekeeping                     £
5. Misc goods and Services                   £
6. Personal and Leisure                      £
7. Sundries/emergencies/other                £
                                        Total £

				
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