APPLICATION FOR HELP WITH CURRENT CHARGE

← Back to document page

Ref: BDSDate received:Telephone: 0300 123 TELL US ABOUT YOURSELFWHO SHARES YOUR HOME WITH YOU?MrNameFull name of each adultHow many children 16 and under live with you? How many children 16 and over live with you? Age of each child under 16Age of each child over 16AddressDate of BirthPhoneEmailPostcodeMrsMissMsOtherI live aloneIf YES, please tell us who Are you or anyone in your household disabled?WifeHusbandPartnerChildrenOther 1APPLICATION FOR HELP WITH CURRENT YOU IN DEBT WITH ANY OF THE FOLLOWING? Amount of Weekly Arrears payment/offerRent Mortgage Secured loan Council tax Gas Electricity Court fines Amount of Weekly Arrears

Advice agencies may submit their own financial statement if preferred INCOME OTGOINGS Wages/Salary Housing Costs Your take home pay Rent Partner’s take home pay Mortgage

  Applications