IND Income and Expenditure Form

Welcome to the IND Income and Expenditure form. Please fill in all fields below, if you're having issues please feel free to contact us for a paper version.

First name:    
Surname:    
Address:    
     
Town:
Post code:
       
Marital status:
Dependants under 19yrs old:
IND reference no:*

If you do not know your reference number, please give us a call on 0333 772 0764.

Your income (we need to see proof of all your income)
Weekly Monthly
Wages: £ £
Your partner's wages: £ £
Company pension: £ £
Income support: £ £
Jobseekers allowance: £ £
Child benefit: £ £
Working tax credit: £ £
Child tax credit: £ £
Incapacity benefit: £ £
Pension credit: £ £
Bereavement benefit: £ £
Carers' allowance: £ £
Other state benefits: £ £
     
Please specify - other state benefits:  
     
Maintenance: £ £
Money from anyone who lives with you: £ £
Housing benefit: £ £
Council tax benefit: £ £
Student loan/grant: £ £
Insurance payments: £ £
Other: £ £
     
Please specify - Other:  
       
TOTAL INCOME: £ £

Important note:
The purpose of this form is to help you and your creditor to establish the correct way in addressing your debt to IND Ltd.

IND will assess the information you provide based on your subbmision and the documentry evidence you will supply, such as wages slips, bank account statements, rent agreements and any other documents which can support your submission.

Make your offer of payment against the debt you owe in box 'Your offer of repayment' of this form. If you make no offer we will decide, based on the information you supplied how much and when you should pay.

You must sign the declaration in part 'Signed:' of the form which confirms that you admit owing the debt and contains statement of truth.

Your spending (we need to see proof of all regular spending)
Weekly Monthly
Mortgage payments: £ £
   
Address of property:  
     
Mortgage protection policy: £ £
Second mortgage or a loan secured on your home / life assurance or endowment premiums: £ £
Rent: £ £
Council tax: £ £
Ground rent: £ £
Buildings and contents insurance: £ £
Utilities:
Water charges: £ £
Electricity: £ £
Gas: £ £
Other fuel or heating costs: £ £
Groceries and toiletries: £ £
TV rental: £ £
TV license: £ £
Maintenance payments: £ £
Travelling expenses: £ £
School meals and meals at work: £ £
Clothing and shoes: £ £
Laundry: £ £
Phone expenses: £ £
Prescriptions, dentist and glasses costs: £ £
Child's pocket money: £ £
Child minding costs: £ £
Child maintenance: £ £
Pension payments including additional voluntary contributions (AVCs): £ £
Pet costs: £ £
Other: £ £
   
Please specify - Other:  
       
TOTAL EXPENSES: £ £
 
Your debts/arrears - please show the amounts you are paying towards any debts you have.
Weekly Monthly Total Bill
Rent arrears: £ £ £
Mortgage arrears: £ £ £
Unpaid council tax: £ £ £
Credit debts: £ £ £
Please specify - how many credit debts:   
Overdue water rates: £ £ £
Fuel debts      
gas: £ £ £
electricity: £ £ £
other: £ £ £
   
Please specify - other:  
       
Court orders: £ £ £
Unpaid maintenance: £ £ £
Other (please list bellow)      
£ £ £
£ £ £
£ £ £
£ £ £
       
TOTAL DEBTS: £ £ £
       
Bank and building society accounts - if you have any bank or building society accounts or other savings, tell us about them here.
Name of bank or building society Account number Amount held
£
£
£
£
 
Futher information - in the space below, give us any other information you think we need.
       
Employers name and address:
       
Employers telephone number:
Employers e-mail address:
       
Contact telephone number:
E-mail address:
       
Your offer of repayment Weekly Monthly
Please confirm what you feel you can afford per week/month. £ £
       

I declare that the details I have given above are true to the best of my knowledge and you have read and accept our terms and conditions here

       
Signed: