Jan 2016

FINANCIAL ASSESSMENT FOR CARERS WHO ARE CONSIDERING AN ADAPTATION TO THEIR PROPERTY

For social workers to initiate with carers as part of Application Form.

Financial Assessment

Verification of the details provided will be required.

  1. Details of Income

Please provide details of your monthly income.

Details of Previous Year’s P60 / Applicant 1 / Applicant 2
Detail of Previous Year’s P11D
(Taxable Expenses) / Applicant 1 / Applicant
Income / Applicant 1 / Applicant 2
Net Wages/Salary (after deductions)
Child Benefit
Child Tax Credit
Working Tax Credit
Income Support
Retirement Pension
Private Pensions
Job Seekers Allowance
Carers Allowance
Incapacity Benefit
Disability Living Allowance
Pension Credit
Housing Benefit
Council Tax Benefit
Maintenance
Net Income from Property
Other (please specify)
Approx Monthly TOTAL
(see note overleaf)**

** How to work out your monthly income:

  • If you are paid weekly, times the income by 52 then divide by 12
  • If you are paid 4 weekly, divide by 4 then times by 52 (e.g. some forms of benefit)
  • If the amount is paid annually, divide by 12
  1. Details of Expenditure:

Please include details of your monthly expenditure**

Household Expenditure / Applicant 1 / Applicant 2
Rent/Mortgages
Buildings/Contents Insurance
Mortgage Protection Insurance
Council Tax
Water Rates
Electricity/Gas
Monthly Shopping, (Food/toiletries/cleaning products)
Clothing
Health Care Costs (prescriptions/glasses)
Car/Travel (incl. tax, petrol, maintenance)
Car Insurance(s)
Telephone/ Mobile(s)
Pensions
Redundancy/Critical Illness/ Income Protection Insurance
Payments on Credit Cards
Payment on Home Improvement Loans
Payment on other Loans/Debts
Payments into Savings Accounts
Child Care Expenses
Registered Provider? Yes/No
Child Support Commitments
TV Licence
Holidays
Leisure/Activities
Hair Cuts/Beauty
Eating out/Takeaways/Dinner money
Pet food/insurance/health costs
Charitable donations
Other (please specify)
Approx monthly
TOTAL

** Your monthly expenditure can be calculated in the same way as your monthly income

  1. Savings and Investments:

All SAVINGS and INVESTMENTS (Joint and Single Accounts) / Amount Invested
Name of Bank/Building Society
Other Investments (state type)
TOTAL INVESTMENTS
  1. Loans and Credit Card Balances

Loans
Purpose of Loan / How much for? / Monthly amount paid / Date due to finish
Credit Cards
How much owed? / Monthly amount paid
  1. Mortgage

Date of Purchase / Term / Amount of loan / Balance outstanding / Estimated value of property
  1. Disposable Income:

Monthly Amount
Current Total Income
Current Total Expenditure
Disposable Income

1