Freephone
0800 5977977


Individual Questionnaire

 
Attention of (if known)
FIRST NAME
LAST NAME
PREVIOUS NAME (if applicable)
DATE OF BIRTH
MARITAL STATUS
RESIDENTIAL ADDRESS
(inc. postcode)
HOME TEL. NO.
MOBILE TEL. NO
EMAIL
OCCUPATION
EMPLOYMENT TYPE


SCHEDULE OF ASSETS (EXCLUDING VEHICLES AND PROPERTIES SAVINGS)

ASSET DESCRIPTION & APPROXIMATE VALUE
SAVINGS
PETTY CASH
CASH AT
BUILDING SOCIETY
SHARES
PREMIUM BONDS
ENDOWMENT
POLICIES
LIFE ASSURANCE
POLICIES
PENSION FUNDS
OTHER


HISTORY AND BACKGROUND

The “History and Background” is an important part of the proposal and its purpose is to give the reader an overall picture of how your present circumstances have arisen. It should be ideally ¾ page of A4 paper and should include the following information:
 
Your name, where you live, and whether you are employed and for whom you work, or whether you are self-employed and the type of business you run.
Your marital status (married/single/co-habiting), and whether you have any children.
Your current home status i.e. Mortgage payer or renting, sole or joint.
If self-employed, when the business started, from where it traded, how it was financed and how trading went initially.
A brief summary of what went wrong or the change in circumstances, including things that were beyond your control, such as bad debts, unforeseen items of expenditure, loss of a major contract, theft, vandalism, illness etc. It helps if the chain of events described is likely to provoke a sympathetic response from creditors.
An explanation for each of your major liabilities should be given in as clear a manner as possible.


MONTHLY PERSONAL INCOME AND EXPENDITURE SHEET

Monthly income
Net wage after PAYE
Drawings from business
Spouses net wage
Income support
Family credit
Pension
Child benefit
Child maintenance
Non-Dependants
Other Income please specify
Total monthly income (A)
Less:Monthly expenditure (B)
Surplus (A-B)
Amount available for creditors

Number of persons in house hold

MONTHLY EXPENDITURE

£

Mortgage 1
Mortgage 2
Rent
Council Tax
Water Rates
House Contents insurance
TV License
Car HP
Car Tax
Car insurance
Car Maintenance
Life Insurance
Housekeeping
Traveling Costs
School Meals
Clothing
Gas
Electric
Telephone
Other expenses not mentioned
Total monthly expenditure

Outstanding Court Actions

Name of Creditor Name of court How much is being claimed Type of action Dates of forthcoming hearings

Creditor List

Names of parties of whom you owe money to Joint or sole debt Amount Outstanding & reference number Solicitor/Debt collectors name address and reference and contact name Action

Asset Questionnaire Motor Vehicles Owned and used

Vehicle make & Model Finance company Reg: Owner of vehicle Present Mileage Date of purchase Present
Vehicle Value
Outstanding Amount to Finance Company

Asset Questionnaire
Details of properties currently or previously owned or occupied

Address of property including postcode Freehold Leasehold/ Rented ETC Name(s) of owners /landlord and address Dates of entry/ acquisition Date property vacated Cost price Present value
(We need a recent valuation from an estate agent or valuer)
Value of mortgages/ charges/ unpaid rent (Please provide statement)

 

UK Bankruptcy Limited is a licensed debt adjuster with the Office of Fair Trading. Consumer credit license (uk) 493009
UK Bankruptcy Limited, Alton Chambers, 37 Church Road, Lower Parkstone, Poole BH14 8UF
Freephone: 0800 5977977 | Fax: 01202 740608 | Email:
enquiries@bankruptcy.co.uk