Rossendale Citizens Advice Bureau

Expenditure sheet –

please state if weekly, fortnightly, four-weekly, quarterly, or annually in each case

Name …………………………………………..……………

EARNED INCOME - please state if weekly, fortnightly, four-weekly, quarterly, or annually in each case / Amount £ / How often
1. Your wages / salary (take home)
2. Partners wages / salary (take home)
5. Maintenance/Child Support received
6. Board, etc from official boarders/lodgers
7. Board/contribution from non-dependant children
8. Student Loans and Grants
9. Other (please state)
BENEFIT INCOME -
please state if weekly, fortnightly or four-weekly, in each case
10/11. Job-seekers Allowance (JSA)
12. Income Support
13. Working Tax Credit
14. Child Tax Credit
15. Child Benefit
16. Incapacity Benefit/SSP/ESA
17. Disability Living Allowance - state each component
17. Attendance Allowance
18. Carer’s Allowance
19. Housing Benefit
19a. Council Tax Benefit
20. Other (Maternity, SMP, etc)
21. Other eg Industrial Injuries Disablement Benefit
PENSION INCOME -
please state if weekly, four-weekly or monthly, in each case
22. State Retirement Pension(s) – you and partner
23. Private or Work Pension(s) - you and partner
24. Pension Credit
25. Other
POSSESSIONS / Estimated Value / Outstanding Debt / Nett
House/Flat
Car(s) No. -
Motorbike
SAVINGS / Amount
Building Societies/banks
ISA/Tessa
Other, eg Credit Union
/ Amount £ / How often
32. Rent
33. Ground Rent/Service Charges
34. Mortgage
35. Other Secured Loans
36. Mortgage Endowment
37. House/contents Insurance
38. Life Insurance and pensions
39. Council Tax
40. Gas
41. Electricity
42. Water
43. Other utilities (coal, oil, calor gas, etc)
44. T V Licence
45. Magistrates Court Fines
46. Maintenance/Child Support
47. Hire Purchase/Conditional Sale
48. Childcare
53. Home telephone
54. Mobile telephone (including dependent children’s)
56. Transport costs e.g. bus, taxi
58. Car Insurance – for each vehicle
59. Vehicle Road Tax - for each vehicle
60. Fuel – for each vehicle
61. MOT and car maintenance - for each vehicle
62. Breakdown or recovery - for each vehicle
63. Parking charges/tolls
65. Food and milk
66. Cleaning and toiletries
67. Newspapers and magazines
68. Cigarettes and tobacco
69. Alcohol
70. Laundry and dry-cleaning
71. Clothing and footwear
72. Nappies and baby items
73. Pet food
75. Health costs (prescriptions, dentist, glasses)
76. Repairs/house maintenance (inc window cleaning)
78. Cable/ satellite rental, internet
79. TV, Video, other appliance rental
80. School Meals
81. Children’s pocket money and school trips
86/87. Other expenditure (excluding your debts, which should be listed on the separate sheet)– please give details

2

Apr-09