Pre-Court Protocol Checklist
PERSONAL BUDGET SHEET
NAME ………………………………………………………………………………………..
ADDRESS………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Please give the amount you receive weekly
If there are any amounts that you receive monthly, just divide the amount by 4 to give an estimate of how much the weekly amount is.
STEP 1 - INCOME
WEEKLY INCOME
Wages/Salary / £Wages/Salary (partner) / £
Income Support / Pension Credit / £
Retirement/Works Pension / £
Incapacity Benefit / £
Job Seekers Allowance / £
Tax Credit / £
Child Benefit / £
Incapacity Benefit / £
Maintenance / £
Non-dependants contributions / £
Other / £
TOTAL WEEKLY INCOME
BOX A
STEP 2 – OUTGOINGS
WEEKLY OUTGOINGSRent (Not including arrears) / £
Council Tax (Not including arrears) / £
Water Rates (Not including any arrears) / £
Service Charge / £
Buildings/Contents Insurance / £
Gas (Not including any arrears) / £
Electric (not including any arrears) / £
Other fuel (Not including any arrears) / £
Housekeeping / £
TV Rental/Licence / £
Magistrates Court fines / £
Maintenance Payments / £
Hire Purchase vehicle / £
Travelling Expenses / £
School Meals/Meals at work / £
Clothing / £
Laundry / £
Telephone/Mobile Phone / £
Prescriptions/health costs / £
Childminding / £
Other 1 / £
Other 2 / £
Other 3 / £
TOTAL OUTGOINGS - BOX B
STEP 3
AMOUNT LEFT AFTER GENERAL EXPENDITURE
STEP 4 – PRIORITY DEBTS
PRIORITY DEBTS (WEEKLY)Rent Arrears / £
Council Tax Arrears / £
Gas / £
Fuel Debts:(Arrears only)
Gas
Electric
Water
Other fuel debts / £
£
£
£
£
Fines / £
Maintenance Arrears / £
Hire Purchase Arrears / £
Credit Card Arrears / £
TOTAL PRIORITY DEBTS
BOX D
STEP 5
AMOUNT LEFT FOR DEBT PAYMENTS
This is an accurate record of my/our financial position
Signed ______
Date______
PLEASE REMEMBER THAT IF YOUR INCOME CHANGES YOU MUST INFORM COUNCIL HOUSING SERVICES AND HOUSING BENEFITS
Lancaster City Council
Council Housing Services
38 Cable Street
LA1 1HH
01524 - 582929