Income & Expenditure Form

Your Details

Your Household

Household Income

Weekly (£)

Monthly (£)

Wages/Salary

Partner's Wages/Salary

Pension

Other Income

Benefits

Housing Benefit

Universal Credit

PIP (DLA)

LCW/LCWRA (ESA)

Child Benefit

Carers Allowance

Pension Credit

Totals

Total Income Combined

Expenditure

Weekly (£)

Monthly (£)

Housing & Utilities

Rent/Mortgage

Council Tax

Service Charges

Gas

Electricity

Other Fuel

Water Supply

Waste Water

House Insurance

Mobile Telephone

Broadband

TV Licence

Health & Personal

Life Insurance

Prescription Costs

Dentist

Optician

Haircuts

Food & Household

Groceries

Toiletries

Clothing/Footwear

Childcare Costs

Pet Food/Vet

School Meals

School Trips

Alcohol

Smoking Products

Transport

Petrol/Diesel

Insurance

Vehicle Tax

MOT

Breakdown cover/Maintenance

Parking Costs

Finance Agreements

Public Transport

Subscriptions

Netflix

Amazon Prime

Sky+

Disney+

Now TV

Apple TV

Paramount+

YouTube Premium

Spotify

Apple Music

Gym

Yoga/Fitness class

Health/Wellness app

Personal Trainer

Magazine/Newspaper

Audible/Audiobooks

Kindle Unlimited

iCloud Storage

Google One/Drive Storage

Microsoft 365

Adobe Creative Cloud

Antivirus/Security software

Gaming Subscription (Xbox, PS Plus, etc.)

Outstanding Debts

Rent/Mortgage Arrears

Council Tax Arrears

Income Tax

Gas Arrears

Electricity Arrears

Water Arrears

Other Secured Loans

Court Fines

Wage Attachments

Child Maintenance

Any Other Debts or Expenditure

Totals

Total Expenditure Combined

Additional Comments

Repayment

Offer of Repayment:

Repayment Frequency:

WeeklyMonthly

Please be aware that arrangements are discretionary, we are not obliged to accept any offer of repayment from you.

Before any arrangement is considered you are required to provide 3 months of recent bank statements and/or supporting evidence.

Failure to adhere to this request may result in enforcement action, that may incur you further costs, being taken without further notice.

Supporting Documents

You may upload up to 3 files. Maximum size per file is 4MB

Choose file

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Get in touch with us

Whether you need help with debt recovery, enforcement services, or have a general enquiry, our team is ready to assist. Reach out today and we’ll get back to you as soon as possible.

Have any questions?

+44 1622 683308

Send email

info@stanfordandgreen.co.uk