Assets & Liabilities

Assets & Liabilities

Complete this form for household income, expenditure, protection, assets, and liabilities. Use the business details and household figures requested, and follow the note that only one form should be completed for husband and wife.
Personal Income and Expenditure (excluding business commitments)

Only complete one form for husband and wife
Name of your business
Date

MonthDayYear
Date
Name(s)
Current occupation(s) and employer(s) name
Monthly Income
Income from employment (£/month)
Other income 1 - specify
Other income 1 amount (£/month)
Other income 2 - specify
Other income 2 amount (£/month)
Spouse/Partner’s income (£/month)
Child Benefit (£/month)
Income Support (£/month)
Total Income
Monthly Expenditure
Mortgage Payment/Rent
Pension
Buildings/Content Insurance
Other Credit Commitments
Loans/Hire Purchase (£/month)
Credit/Store Cards (£/month)
Other Regular Commitments
Council Tax/Water Rates (£ per month)
Domestic Fuel (£ per month)
Telephone (£ per month)
Travel Costs (£ per month)
Car Tax/Car Insurance (£ per month)
Food (£ per month)
Clothing/Hobbies/Leisure (£ per month)
Other Regular Commitments (e.g. life cover/critical illness etc.) (£ per month)
Total Monthly Expendinture
Main Residence Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Main Residence Value / Mortgage Outstanding (£)
Mortgage Lender
Total Investment Properties
Number of Lenders
Protection
Do you have life cover?
Level of cover (£)
Do you have income protection?
Level of cover (£)
Do you have critical illness cover?
Level of cover (£)
Do you have a pension?
Pension value (£)
Assets
Total Gross Property Value (from above) (£)
Savings (£)
Other investments (£)
Shares (£)
Life Policies (surrender value) (£)
Other (please specify) description
Other (please specify) amount (£)
TOTAL ASSETS
Liabilities
Total mortgage outstanding (£) (from above)
Loans (£)
Other debts (e.g HP) (£)
Credit card debt (£)
TOTAL LIABILITIES
Signature
Should be Empty:

Assets & Liabilities

Personal Income and Expenditure (excluding business commitments)

Monthly Income

Monthly Expenditure

Other Credit Commitments

Other Regular Commitments

Protection

Assets

Liabilities