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1: What is your total monthly income?

i: Wages including bonus: £0

£0 £10k

ii: Partner income: £0

£0 £10k

iii: Benefits: £0

£0 £2k

2: What is your employment status?

3: How much do you owe for each of the following?

i: Mortgage Amount outstanding: £0

£0 £500k

ii: Secured loan(s): £0

£0 £100k

iii: Unsecured Loans and Credit cards (including overdrafts, store cards etc): £0

£0 £100k

iv: How many unsecured debts do you have? 0

1 20

1: How many people living in your household?

i: Adults:

ii: Dependent children (under 16 years of age):

2: How many cars in your household?

i: How many cars in your household:

3: What are your monthly living costs?

i: Mortgage/Rent: £0

£0 £3k

ii: Home and Contents insurance: £0

£0 £100

iii: Council Tax: £0

£0 £450

iv: Gas: £0

£0 £200

v: Electricity: £0

£0 £200

vi: Water: £0

£0 £200

vii: Mobile: £0

£0 £100

viii: Telephone: £0

£0 £100

ix: Cable/Sky Package: £0

£0 £100

x: Internet: £0

£0 £100

xi: Travel Costs: £0

£0 £600

xii: Car insurance: £0

£0 £300

xiii: Food and Housekeeping: £0

£0 £800

xiv: Childcare: £0

£0 £1000

xv: Other: £0

£0 £800

1: Please select all those that are relevant for your current circumstances?

Do you lose sleep worrying your debts?
Do you regularly ignore bills and reminders?
Do you only make the minimum monthly payment on credit cards?
Have you argued with friends or family regarding your finances?
Do you worry about your income?
When paying with your debit or credit card do you worry they may be declined?
Do you fear the telephone ringing?
Have you missed any utility, council tax, mortgage or rent payments recently?
Do you have any County Court Judgments (CCJs)?
Do you have debt collectors knocking at your door?
Do you have a hire/purcase car outstanding?
Do you have arrears on any rent, utilities, tax?

Your details

Your First Name:

Your Last Name:

Your Telephone Number:

Your E-mail Address:

Your Finances

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