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					March 2012 new debt pack.Final.doc


                      DEBT PACK PROFILE (for completion by Client)

First of all, thank you for seeking money advice from Citizens Advice Edinburgh. In order to assess
your case and help you, we need full details about your personal details and circumstances, your
income and expenditure and full details about your debts and your creditors,.

                                    DETAILS AND CIRCUMSTANCES:

We need to know your particular circumstances to identify the urgency of your problem and give
you the correct advice. Please complete all details where possible.

Title:…………….                   Forename:…………... …….. Surname:………………………

Address:………………………………………………………………………………………………………
……………………………………… Postcode:………………….

Contact Telephone Number:……………………………………………………………….

STATUS
Date of Birth                    You            Partner          Please tick one         You          Partner
                                                                 Divorced
Nat Insurance No                                                 Married
                                                                 Cohabiting
Nationality (If not British,                                     Separated
residency status)                                                Single
Male                                                             C Partnership
Female                                                           Widowed

FAMILY (Children or dependents)                                PROPERTY                              You Partner
Relationship                   Date of birth                   Owned
                                                               Mortgaged
                                                               Arrears
                                                               Registered Social Landlord
                                                               Private Tenant
                                                               Council tenant
                                                               Other/carer (please give details)

EMPLOYMENT                                                     BENEFITS
Employed:               Please tick one                   Benefit Type                         You      Partner
                        You     Partner
Full time                                                 Inc Support/JSA/ESA
Part time                                                 Housing Benefit
Unemployed                                                Council Tax Benefit
Job start                                                 Tax Credits? which
Job end date                                              DLA/ IB
Pensioner                                                 Other
Student
Self employed                                             Official Use only
Other                                                     Benefit Check Required

HEALTH ISSUES
Please let us know if you have any condition affecting your ability to manage your finances.




                                               CAE Debt Pack   Page 1 of 9
March 2012 new debt pack.Final.doc




                  MONEY ADVICE PROCESS
We will
   Assess your income and advise where appropriate how this may be increased (e.g.
        claiming benefits)
   Contact your creditors to say we are helping, confirm balances due and negotiate as
        appropriate.
   Compile a financial statement showing income, essential expenditure and a list of creditors
        and balances. This will show you if you have any income available with which to make
        offers.
   Discuss all of the options available to you that will help to resolve the difficulties, pointing
        out the pros and cons of each option
   Help you decide which option might be best for you
   Refer you to other appropriate organisations with your permission
   Maintain confidentiality at all times, only taking action after discussing it with you first.
   Hold all information in line with our Data Protection Policy.
   Be non-judgemental. It does not matter to us how or why you are experiencing difficulties.
        All clients will be offered the same impartial service.
   Reserve the right to withdraw our services if you do not maintain contact, or if you wish to
        pursue a course of action to which we do not wish to be party (and we will advise you of the
        consequences of such action)
   Not discriminate between clients on grounds of race, gender, religion, disability, sexual
        orientation or age.

We would like YOU to:
   Complete this debt pack, attaching the most recent account statements, and bring us proof
     of your income/benefits
   Attend any appointment arranged, or let us know in advance if you are unable to attend. If
     you miss more than two appointments without letting us know, we may assume that you no
     longer need help and close your case.
   Supply all the relevant details of your circumstances, including all incoming and outgoings.
     We must have this information in order to ensure that we give you the correct advice.
   Keep us informed of any changes in your circumstances or difficulties in making any agreed
     payments.
   Not enter into separate agreements with your creditors and not take out further credit.
   Not approach other money advice services while asking us to act on your behalf. Similarly,
     if another money advice agency is helping you, we would not be able to assist you until you
     have ceased contact with them. Creditors will not deal with two agencies acting on your
     behalf at the same time.

You MUST tell us
    Which bank accounts or cards you are using to get income/benefits and pay your current
      living necessities (page 6)
    If any debts are nearing 5 years since payment was made or you wrote to the creditor
      about it.



If you accept this process and wish our help or advice with managing your debts please sign below

Signed (Client)…………………………………………………….                                Date ……………




                                      CAE Debt Pack   Page 2 of 9
      March 2012 new debt pack.Final.doc


                                                   INCOME
                                                        Amount £                         Period                  Official
                                                                              (Weekly / Fortnightly / Monthly)   Use Only
1. Client’s net earnings
2. Partner’s net earnings
3. Other net earnings
4. TOTAL wages
Other Income
5. Maintenance/Child Support
6. Boarders/Lodgers
7. Student Loan
8. Student Grant or Bursary
9. Other sources of income. Please
State:
10. TOTAL other incomes
Pensions
11. Client
12. Partner
13. Other (war, annuity, retirement etc.)
14. TOTAL pensions
Benefits
15.
16
17.
18.
19.
20. TOTAL benefits
21. TOTAL Income

                                                   ASSETS
                                                                          Value £                        Official Use Only

House/Flat
22. Estimated current value
23. Mortgages outstanding
24. Equity
Car/Motorbike
25. Estimated current value
26. HP/Loan outstanding
27. Net value
Savings or Savings Schemes
28. ISA
29. Higher Rate Deposit
30. Buildings Society
31. Other
32. TOTAL savings or savings schemes
Other assets or opportunities for lump sum payment (eg
savings accounts, bonuses etc)
33
34
TOTAL Assets



                                            CAE Debt Pack   Page 3 of 9
                                 EXPENDITURE
Housing Costs:                                       Amount £      Period          Official
                                                                Weekly/f’nightly   Use Only
                                                                  monthly
1. Rent
2. Mortgage
3. Other Secured Loans (2nd Mortgage)
4. Council Tax
5. TOTAL housing costs
Other Housing Costs
6. Mortgage Payment Premium
7. Ground Rent & Service Charge
8. Contents Insurance
9. Building Insurance
10. Mortgage Endowment Policies/ISA
11. Other Life Assurance linked to mortgage
12 Other Housing Costs
13. TOTAL other housing costs
Utilities
14. Gas
15. Electricity
16. Other
17. TOTAL utilities
Other Important Items
18. Court Orders
19. Maintenance/Child Support
20. Pension Payments/AVCs
21. Other Life Assurance
22. HP/Conditional Sale
23. TV Licence
24. Telephone/s (Landline)
25. Mobile Phone/s
26. Broadband/Internet
27. TOTAL other important items
Housekeeping
28. Food/Milk
29. Cleaning/Toiletries
30. Papers/Magazines
31. Cigarettes/Tobacco/Sweets
32. Alcohol
33. Meals at Work
34. Laundry/Dry Cleaning
35. Clothing/Footwear/Uniform
36. TOTAL Housekeeping




                               CAE Debt Pack   Page 4 of 9
                          EXPENDITURE (Continued)
Travel                                             Amount    Period w/f/m
37. Fares to work
38. Fares to school
39. Fares to go shopping
40. Other Fares (e.g. hospital visits etc.)
41. Road Tax
42. Vehicle Insurance
43. Petrol/Oil/Diesel
44. MOT/Maintenance
45. Breakdown/Recovery
46. Parking Charges & Tolls
47. TOTAL Travel
Children
48. Childcare
49. Nappies/Baby Items
50. School Fees
51. School Meals/Trips
52. Children’s Pocket Money
58. TOTAL Children
Health
53. Dentist/Prescriptions/Glasses
54. Care Costs (other than children)
55. Health Insurance
56. TOTAL Health
Pets
57. Pet Food
58. Vet Bills/Insurance
59. TOTAL Pets
Repairs and Maintenance
60. Repairs
61. Household Maintenance
62. Window Cleaning
63. Maintenance Contracts
64. TOTAL Maintenance Contracts
Other Expenditure
65. Memberships/Professional subs
66. Postage
67. Hairdressing/Haircuts
68. TV/Video/Sat/Cable
69. Other Appliance Rental
70. Pub/Outings
71. Lottery
72. Hobbies (e.g. gardening)_
73. Religious & Charitable giving
74. Gifts
75. TOTAL Other Expenditure
TOTAL EXPENDITURE                                 £
TOTAL INCOME                                      £
DISPOSABLE INCOME LEFT FOR DEBTS                  £

                               CAE Debt Pack   Page 5 of 9
                            BANK ACCOUNT INFORMATION
You are strongly advised to change Bank Accounts if you have a debt with the one you use as
a current account OR you are struggling with an overdraft.


Which bank account do you use: to receive your benefits, income, salary, or wages
Name of Bank          __________________________
Name on Account       __________________________
Account Number        ___________________________
Sort Code             ___________________________


Which bank account do you use: To pay direct debits or standing orders, make cash
withdrawals, write cheques or pay any other bills
Name of Bank          __________________________
Name on Account       __________________________
Account Number        ___________________________
Sort Code             ___________________________



                                 ACCOUNTS BEING USED
We will be writing to your creditors to let them know we are helping you. This means they will
know you are struggling to make payments. If you need to use any accounts, tell us why –
discuss with Adviser please.

 ACCOUNT - COMPANY            ACCOUNT NUMBER                       What you are using the
 NAME                                                              account for




Use reverse of sheet if necessary.




                                     PRIORITY CREDITORS
                                     CAE Debt Pack   Page 6 of 9
You must tell us if you have arrears with any of these so we can treat them as a matter of priority. If you have
utility arrears with the current provider, contact them immediately by phone to avoid disconnection
                                   Name, Address and Account                  Payment Arrears              Offical
                                          Reference Number                     due £           £          Use Only
                                                                                                           Holding
                                                                            (weekly/m                     Letter to
                                                                               onthly)                    be sent?
                                                                                                          YES/NO
      Creditor Type                                                                                           ?
Landlord/Rent:


  Acc Reference No.
Mortgage Lender:


Acc Reference No.
Secured Loan


Acc Reference No.
Council Tax


Acc Reference No.
Sheriff Officers:


  Acc Reference No.
Fuel: Electricity


  Acc Reference No.                                                                                      NO
Fuel Gas:                                                                                                NO


      Reference No.
Court Fines:


  Acc Reference No.
Maintenance Payts.


   Acc Reference No.
Social Fund or
other Government
Debts
   Acc Reference No.



                                        CAE Debt Pack   Page 7 of 9
                                                                           OTHER CREDITORS
       Include all debts where you are NOT managing to pay the amount due EVEN when the creditor has agreed to accept lower payments temporarily
Debt type codes: BL = bank loan        BO = overdraft          C = catalogue        F = Finance co      CC = credit cards     HP = Hire Purchase   T = income tax    SC = store credit
M = miscellaneous
No Account            Name and Address of Creditor             Name and Address of Collector            Debt    Balance       What you are    Date last      Is debt nearing   OFFICIAL
      holder name     Reference Number of Account              Reference Number                         type    outstanding   supposed to     payment        5 years since a   USE
                      (Both Original Creditor AND              Both Original Creditor AND               *       £             pay per         made?          payment was       ONLY –
                                                                                                                                                                               Holding
                      Collector details are required if your   Collector details are required if your                         week/month      How much?      made or you
                                                                                                                                                                               letter to
                      debt has been passed on for              debt has been passed on for                                                                   wrote to          go? y/n
                      collection)                              collection)                                                                                   creditor?
                        Original Creditor name & address       Debt Collector name & address




                        Account ref                            Account ref no if
                        no:……………………………………                      different……………………………..
                        …..
                        Original Creditor name & address       Debt Collector name & address




                        Account ref                            Account ref no if
                        no:……………………………………                      different……………………………..
                        …..
                        Original Creditor name & address       Debt Collector name & address




                        Account ref                            Account ref no if
                        no:……………………………………                      different……………………………..
                        …..
                        Original Creditor name & address       Debt Collector name & address




                        Account ref                            Account ref no if
                        no:……………………………………                      different……………………………..
                        …..
                                                                                     CAE Debt Pack       Page 8 of 9
                           Citizens Advice Edinburgh
                              DUNDAS STREET OFFICE
                        CONSENT/AUTHORISATION FORM

Name(s):…………………………………………………………………....

Address:…………………………………………………………………….

Postcode:……………………………………


I/ We authorise:

                     Citizens Advice Edinburgh
                     58 Dundas Street
                     Edinburgh
                     EH3 6QZ

to pursue enquiries, to receive information and to negotiate on my/our behalf in respect of:
my/our financial affairs


DATA PROTECTION ACT 1998

In order to help you, we need to maintain a record of your case, which may contain
sensitive personal data. The law says we must get your consent to do this. Everything you
tell us will be treated with strict confidentiality, in accordance with the principles of our
organisation.

I/We give my/our consent to CAE to maintain a record of my/our case, which may
include any sensitive data.


Signed: ………………………..                       Date: …………………………..

Signed: ………………………..                       Date: …………………………..



Note for creditors: CAE operates a policy of allowing clients access to information
held about them. However, in the exceptional case, if the information you provide in
whole or in part is to be withheld from the client, then this must be clearly stated.




                                    CAE Debt Pack   Page 9 of 9

				
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