Debt Management Application Pack

Transcription

1 Debt Management Application Pack Debt Clear Solutions is delighted to enclose an information and pre-application pack that will enable us to help you identify the right Debt Management Plan for you. In order for Debt Clear Solutions to help you secure the right Debt Management Plan you need please complete and sign the attached Personal Fact Find, Assets, Income and Expenditure Questionnaire and Statement Of Truth. What You Need To Do Next: 1. Read all the documentation you have been sent. 2. Fill out the Personal Fact Find, Personal Assets, Income and Expenditure, Questionnaire and sign the Statement of Truth. 3. Return completed forms to Debt Clear Solutions Ltd, 501 International House, 223 Regent Street London W1B 2QD Who is Debt Clear Solutions? Debt Clear Solutions Ltd is regulated by the Ministry of Justice and registered with Data Protection. This ensures all of your information is safe and secure and will not be passed on to any third party without your permission.

2 Title: Forename(s): Surname: Date of Birth: Gender: Marital Status: (e.g. married, single) Number and ages of any dependents: Living Arrangements: (e.g. home owner, tenant) Personal Fact Find Applicant One: Applicant Two: (If Applicable) Current Address: Time at Address: Previous Address: (If less than 6 months) Phone Number: Mobile Phone Number: Daytime Phone Number: Evening Address: Best Contact Time: Employment Status: (e.g. Employed/Self Employed) Job Title: Time in job:

3 Personal Assets Homeowners Tenants Type of Property: (e.g. detached, apartment) Number of Bedrooms: Name(s) of legal owners of property: Name(s) on rental agreement: Current Mortgage Company: Type of Mortgage (e.g. self cert, repayment): Year of purchase: Have you ever re-mortgaged? If so for what reason? Date of re-mortgage: Amount of re-mortgage: Do you currently have any secured loans? If so for what reason? Name of lender: Date of loan: Do you currently have an endowment policy? Name of provider: Date policy matures: Current Value: Current Value of Property: Mortgage balance on your most recent statement: Amount outstanding on any secured loans: Available Equity: (Value mortgage balance secured loan balance = equity)

4 Mrs Income Mr Income Child Benefit Child Tax Credit Working Families Tax Credit Other Benefits Pension TOTAL MONTHLY INCOME Mortgage/Rent Contents and House Insurance Secured Loan / Endowment Policy Food and Housekeeping Council Tax Electricity Water Rates Gas Telephone Mobile Phone(s) TV Licence Life Policy Personal Pension Car Petrol Car Servicing Car Insurance Car Tax Car Hire Purchase Public Transport Childcare Costs Medical and Dental Clothing Household Maintenance / Contingency Other Monthly Expense Income And Expenditure

5 Statement Of Truth I / We believe that all information given is true and accurate to the best of my / our knowledge. Print Name: Print Name: Sign: Sign: Date: Date:

6 Additional Information Please provide any additional information that may be relevant to your circumstances: