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Funded by the NI Housing Executive

 

Short Financial Statement

Use the form below to prepare a short financial statement to send to your creditors. Use either weekly or monthly figures, and stick to them throughout. If you need help converting the amount into weekly or monthly figures, you can use our converter tool in the DIY Advice Tools section.

Type the figures into the table and the totals will appear when you click on the CALCULATE button. To clear the form click on the RESET FORM button.

Alternatively you can download this form as a PDF.

YOUR DETAILS
Full Name
Street Address
City
Post Code
Account Number

INCOME
Net Wages (After Tax)
Benefits
Family Contribution
Other Income

SPENDING
Mortgage
Rent
Rates
Secured Loan
Insurance
Repairs
Electricity
Gas / Oil
Coal
Telephone
Food, Milk etc
Travel to Work, etc
Car Expenses
Work Expenses
Furniture
TV / Video
Childcare / Medical
Clothes
Pocket Money
Entertainment
Other