NAIRE STATEMENT OF FINANCIAL AFFAIRS

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                QUESTIONNAIRE (STATEMENT OF FINANCIAL AFFAIRS)

 It is important that the information you provide to us is as accurate and complete as possible.Once
                   completed please post the questioner to our head office address:
          Tower Consulting Services Ltd, Progress Centre, Charlton Place, Manchester, M12 6HS

  The information you provide is kept confidential and is subject to provisions of the Data Protection
            Act 1998. It is not disclosed to any third party without your expressed consent.




1. Personal Details
                                         Your Details                   Second Applicant Details

Name

Date of Birth


Address


Are you Homeowner, Tenant
or other (please specify)

Home Telephone No.
Mobile Telephone No.
Work Telephone No.
Email Address
When is the best time to
contact you?
Occupation
Are you employed or self
employed?
Time in job (years)

Marital Status: Married,
Single, Living with Parents,
Divorced, Separated, Co-
Habiting.
Number of Dependants and
ages
2.   Personal Assets
2.1 Residential Property.
Please remember that your house is at risk if you don’t keep up the repayments on your
mortgage/secured loan

Name of owner(s) of
property
Type of property (e.g.
Detached House, Flat etc)
Date property was
purchased
Purchase price (£)

How mach is your property
currently worth? (£)

Name of mortgage lender

Type of mortgage (e.g. fixed
rate, endowment etc)

Mortgage balance (£)
Name of 2nd mortgage
lender
2nd mortgage balance (£)
Name of 3rd mortgage
lender
3rd mortgage balance (£)
Endowment policy monthly
premium (£)
When did the endowment
policy premiums
commence?
Name of secured loan
lender
Secured loan balance (£)




2.2 Life Insurance

                                        Your Details                 Second Applicant Details

Name of Insurer

Monthly premium (£)
2.3 Pension

                                 Your Details   Second Applicant Details

Personal or occupational?

Name of pension provider
Monthly premium (£)



2.4 Motor Vehicle

                                 Your Details   Second Applicant Details
Make and Model
Registration (year)
Current mileage
Are you the legal owner?
Present vehicle value (£)
Is this vehicle on hire
purchase or leased?
Name of finance company

Monthly payment (£)
Start date of finance
agreement
When is the finance due to
finish?
Is there a Balloon Payment?
(£)




2.5 Investments, Savings and Other Assets

                                 Your Details   Second Applicant Details

Current value of savings (£)
Current value of investments
(£)

Do you have any other
valuable assets or
possessions?(e.g. Paintings,
Antiques)
3. Legal Action

                                        Your Details                   Second Applicant Details

Are you up to date with your
credit commitments?
If not please specify.

Are bailiffs threatening to
come to your house?
Have you had CCJs against
you?

Please give us details of any
action from your creditors,
which could result in Legal
Action.




4.  Other Information and Background History


Please provide us with as much information as possible, in relation to events, creditors and dates
which have influenced your current financial situation. Please note that we should be able to explain
to your creditors how and why you arrived in the situation where you cannot meet your contractual
obligations to them. If there is insufficient room in this box please continue on a separate sheet.
5. Your unsecured creditors.
Bank account overdrafts, credit cards, store cards, credit sale agreements, mail order catalogues,
personal loan etc…


                                                                                          Monthly
                                                                   Amount Owing
Creditor’s Name                   Account Reference No.                                   Payment
                                                                       (£)
                                                                                            (£)




TOTALS




6. Monthly Income (£)

                                        Your Details                  Second Applicant Details

Net Income
Child Benefit

Working Family Tax Credit

Other Benefits


Any Other Income


TOTALS
TOTAL FOR YOU & SECOND
APPLICANT
7. Monthly Expenditure (£)


Rent/Mortgage payments
Secured Loan / Endowment
Policy
House Insurance
(building/contents)
Housekeeping (food,
clothes, toiletries, ect.)
Council Tax
Water Rates
Electricity
Gas
Telephone
Mobile Phone(s)
TV License
Life Policy
Personal Pension
Vehicle HP/Lease
Vehicle Petrol
Vehicle Insurance
Vehicle Road Tax
Vehicle Servicing
Public Transport
Childcare Costs

Medical & Dental (i.e.
glasses, prescriptions etc.)


Household Maintenance /
Contingency
Other Expenses


TOTAL MONTHLY
EXPENDITURE


SURPLUS

				
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posted:5/22/2012
language:English
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