Clarity -Affordibility Assessment

Affordability Assessment

Some bills are classed as priorities because the consequences of not paying them are greater than the consequences of not paying others. For example, if you don’t pay your rent or your mortgage you could lose your home.

Some may be priority because not paying them could result in additional financial hardship, for example, if payments are not maintained on an interest free loan, interest could become payable.

The most important ones are not necessarily the biggest ones. Information regarding priority bills can be foundhere.

Your Details

Name

CCMS Number

Date of Birth

Address

Postcode

Land Line Number
Mobile Number
Email

Income

	Amount	Frequency
Salary 1

Salary 2

Pension

Child Maintenance

Rental Income

Benefits Received

Other Income

Description	Amount Received	Frequency

Expenditure

	Amount	Frequency
Mortgage / Rent

Council Tax

Buildings / Content Insurance

Utilities (oil / gas / electricity / water)

Phone / Mobile / Internet

Housekeeping / Food

TV Subscription / TV Licence

Car Insurance / Petrol / MOT / Tax

Childcare Costs

Child Maintenance

Please tick the checkbox below if you are in arrears without a repayment plan for any of the following: Mortgage, Council Tax, Utilities or Secured Loans

Other Expenditure / Priority Bills Arrears

Description	Amount Paid	Frequency

Creditors

Creditor	Amount Paid	Secured	Frequency

Your Offer

Amount	Frequency	Payment Method

Calculations summarised to a monthly amount:
Income	Other Income	Total Income	Expenditure	Other Expenditure	Creditors	Total Expenditure	Available Funds
£0	£0	£0	£0	£0	£0	£0	£0

Would you like to print the form before submitting?

If you are experiencing financial difficulties it may be useful for
you to consult a free independent counselling service.
Here are some examples:
www.stepchange.org
www.payplan.com
www.citizensadvice.org.uk