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Statement of Means

Household

Income

Please leave any comments if required
per month
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Expenses

Please leave any comments if required

Housing

per month
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Household Services

per month
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Child Support Paid by You

per month

Motoring

per month
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Food & Housekeeping

per month
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Clothing

per month

Misc. Goods & Services

per month
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Self Employed

When calculating monthly outgoings/expenditure you should detail all of your expenditure even if it is paid less frequently than monthly eg. All insurances, electric/gas/TV licence, transport costs etc.

Liabilities / Other Debts

Please state Amount Owed, Payment Amount & Payment Frequency for each Creditor/Financial Institution

Proposed Repayment Plan

 

NOTE

Please ensure that all questions in this form are fully answered. Where a question is not applicable, please mark “N/A”. Failure to fully complete the Statement of Means form will result in the form being returned to you looking for the missing information.

 

PLEASE NOTE THE FOLLOWING SUPPORTING DOCUMENTS MAY BE REQUIRED

(Note – All documents must be the most recent available. Note: you can provide a copy of a winter and summer bill for utilities that may change significantly over the year e.g. gas or electricity.  Failure to include any such requested documents will mean that we are unable to rely on the form as proof of your stated current financial position).

  • Your payslip(s) in respect of your employment(s)
  • Your Unemployment Benefit/Assistance payslips (as applicable)
  • Your Disability Allowance payslips (as applicable)
  • Your Old Age Pension Allowance payslips (as applicable)
  • Bank, Credit Union and Post Office Statements (as applicable) of all current, loans and savings accounts
  • Copy Agreements made with other Creditors
  • Any evidence available to show the contributions from the other adult members of the household e.g. Standing Order payment amount

 

DECLARATION

By sending this information, I declare that all of the information entered onto and enclosed in this Statement of Financial Means, which includes those documents, original or otherwise, attached hereon, to represent a true, factual and authentic account of my current circumstances.

 

THIS INFORMATION WILL BE USED EXCLUSIVELY FOR THE PURPOSE OF ALLOWING US TO CONDUCT A REALISTIC AND INFORMED ASSESSMENT OF YOUR PRESENT REPAYMENTS

 

Alternatively you can download the Statement of Means form to fill out offline.